Journal of Preventive Medicine and Public Health

Original Articles

Increase in Potential Low-value Magnetic Resonance Imaging Utilization Due to Out-of-pocket Payment Reduction Across Income Groups in Korea: An Experimental Vignette Study: Yukyung Shin, Ji-su Lee, Young Kyung Do; J Prev Med Public Health. 2022;55(4):389-397. Published online July 11, 2022; DOI: https://doi.org/10.3961/jpmph.22.208

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Objectives
This study examined the effect of out-of-pocket (OOP) payment reduction on the potential utilization of low-value magnetic resonance imaging (MRI) across income groups.
Methods
We conducted an experimental vignette survey using a proportional quota-based sample of individuals in Korea (n=1229). In two hypothetical vignettes, participants were asked whether they would be willing to use MRI if they had uncomplicated headache and non-specific low back pain, each before and after OOP payment reduction. To account for the possible role of physician inducement, half of the participants were initially presented with vignettes that included a physician recommendation for low-value care. The predicted probability, slope index of inequality (SII), and relative index of inequality (RII) were calculated using logistic regression.
Results
Before OOP payment reduction, the lowest income quintile was least likely to use low-value MRI regardless of physician inducement (36.7-49.6% for low back pain; 30.5-39.3% for headache). After OOP payment reduction, almost all individuals in each income quintile were willing to use low-value MRI (89.8-98.0% for low back pain; 78.1-90.3% for headache). Absolute and relative inequalities concerning potential low-value MRI utilization decreased after OOP payments were reduced, even without physician inducement (SII: from 8.15 to 5.37%, RII: from 1.20 to 1.06 for low back pain; SII: from 6.99 to 0.83%, RII: from 1.20 to 1.01 for headache).
Conclusions
OOP payment reduction for MRI has the potential to increase low-value care utilization among all income groups while decreasing inequality in low-value care utilization.

Summary

Korean summary
실험적 비네트 디자인을 활용하여 환자 본인부담금 감소가 잠재적 저가치 MRI 이용에 미치는 영향을 소득 수준별로 분석한 연구이다. 본인부담금 감소로 인해 잠재적 저가치 MRI 이용은 모든 소득 수준에서 증가하고 잠재적 저가치 MRI 이용의 소득 수준에 따른 차이는 감소하는 결과를 보였다.

Citations

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Socioeconomic inequality in organized and opportunistic screening for colorectal cancer: results from the Korean National Cancer Screening Survey, 2009-2021
Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kui Son Choi
Epidemiology and Health.2023; 45: e2023086. CrossRef

Public Preferences for Allocation Principles for Scarce Medical Resources in the COVID-19 Pandemic in Korea: Comparisons With Ethicists’ Recommendations: Ji-Su Lee, Soyun Kim, Young Kyung Do; J Prev Med Public Health. 2021;54(5):360-369. Published online August 26, 2021; DOI: https://doi.org/10.3961/jpmph.21.333

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Abstract Summary PDF Supplementary Material

Objectives
The purpose of this study was to investigate public preferences regarding allocation principles for scarce medical resources in the coronavirus disease 2019 (COVID-19) pandemic, particularly in comparison with the recommendations of ethicists.
Methods
An online survey was conducted with a nationally representative sample of 1509 adults residing in Korea, from November 2 to 5, 2020. The degree of agreement with resource allocation principles in the context of the medical resource constraints precipitated by the COVID-19 pandemic was examined. The results were then compared with ethicists’ recommendations. We also examined whether the perceived severity of COVID-19 explained differences in individual preferences, and by doing so, whether perceived severity helps explain discrepancies between public preferences and ethicists’ recommendations.
Results
Overall, the public of Korea agreed strongly with the principles of “save the most lives,” “Koreans first,” and “sickest first,” but less with “random selection,” in contrast to the recommendations of ethicists. “Save the most lives” was given the highest priority by both the public and ethicists. Higher perceived severity of the pandemic was associated with a greater likelihood of agreeing with allocation principles based on utilitarianism, as well as those promoting and rewarding social usefulness, in line with the opinions of expert ethicists.
Conclusions
The general public of Korea preferred rationing scarce medical resources in the COVID-19 pandemic predominantly based on utilitarianism, identity and prioritarianism, rather than egalitarianism. Further research is needed to explore the reasons for discrepancies between public preferences and ethicists’ recommendations.

Summary

Korean summary
코로나19 대유행으로 가시화된 의료자원의 부족 상황에서 서로 다른 의료자원 배분 원칙에 대한 일반 대중의 선호를 조사한 연구이다. 제시된 여러 원칙 중에서, 공리주의, 한국인 아이덴티티, 약자우선주의에 기초한 배분 원칙이 가장 높은 선호를 보였다. 이러한 결과는, 일반 상황과 달리 감염병 대유행 상황에서는 공리주의에 기초한 배분 원칙을 강화하되 사회적 유용성도 자원 배분의 주요 원칙으로 받아들일 수 있다는 윤리학자들의 견해와는 차이를 보인다.

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Explicit discrimination and ingroup favoritism, but no implicit biases in hypothetical triage decisions during COVID-19
Nico Gradwohl, Hansjörg Neth, Helge Giese, Wolfgang Gaissmaier
Scientific Reports.2024;[Epub] CrossRef
Health Professional vs Layperson Values and Preferences on Scarce Resource Allocation
Russell G. Buhr, Ashley Huynh, Connie Lee, Vishnu P. Nair, Ruby Romero, Lauren E. Wisk
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What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic?
Claudia Calderon Ramirez, Yanick Farmer, Andrea Frolic, Gina Bravo, Nathalie Orr Gaucher, Antoine Payot, Lucie Opatrny, Diane Poirier, Joseph Dahine, Audrey L’Espérance, James Downar, Peter Tanuseputro, Louis-Martin Rousseau, Vincent Dumez, Annie Descôtea
BMC Medical Ethics.2024;[Epub] CrossRef
Consensual ideas for prioritizing patients: correlates of preferences in the allocation of medical resources
Adrian Furnham, Charlotte Robinson, Simmy Grover
Ethics & Behavior.2023; 33(7): 568. CrossRef
Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review
Claudia Calderon Ramirez, Yanick Farmer, Marie-Eve Bouthillier
Discover Health Systems.2023;[Epub] CrossRef

Prescription of Systemic Steroids for Acute Respiratory Infections in Korean Outpatient Settings: Overall Patterns and Effects of the Prescription Appropriateness Evaluation Policy: Taejae Kim, Young Kyung Do; J Prev Med Public Health. 2020;53(2):82-88. Published online November 18, 2019; DOI: https://doi.org/10.3961/jpmph.19.090

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Abstract Summary PDF

Objectives
The objective of this study was to identify individual and institutional factors associated with the prescription of systemic steroids in patients with acute respiratory infections and to investigate the role of a policy measure aimed to reduce inappropriate prescriptions. Methods: We used data from the National Health Insurance Service-National Sample Cohort from 2006 to 2015 and focused on episodes of acute respiratory infection. Descriptive analysis and multiple logistic regression analysis were performed to identify individual-level and institution-level factors associated with the prescription of systemic steroids. In addition, steroid prescription rates were compared with antibiotic prescription rates to assess their serial trends in relation to Health Insurance Review and Assessment Service (HIRA) Prescription Appropriateness Evaluation policy. Results: Among a total of 9 460 552 episodes of respiratory infection, the steroid prescription rate was 6.8%. Defined daily doses/1000 persons/d of steroid increased gradually until 2009, but rose sharply since 2010. The steroid prescription rate was higher among ear, nose and throat specialties (13.0%) than other specialties, and in hospitals (8.0%) than in tertiary hospitals (3.0%) and other types of institutions. Following a prolonged reduction in the steroid prescription rate, this rate increased since the HIRA Prescription Appropriateness Evaluation dropped steroids from its list of evaluation items in 2009. Such a trend reversal was not observed for the prescription rate of antibiotics, which continue to be on the HIRA Prescription Appropriateness Evaluation list. Conclusions: Specialty and type of institution are important correlates of steroid prescriptions in cases of acute respiratory infection. Steroid prescriptions can also be influenced by policy measures, such as the HIRA Prescription Appropriateness Evaluation policy.

Summary

Korean summary
이 연구에서는 요양급여 청구자료를 기준으로 급성 상기도 감염에서 스테로이드를 처방하는 경우와 관련하여 다음과 같은 특징을 확인하였다. 첫째, 환자 특성과 기관 특성을 모두 고려하였을 때 진료과목과 기관의 종별 구분에서 감기 스테로이드 처방률은 상당한 변이를 보였다. 둘째, 약제급여적정성평가 항목에서 스테로이드가 제외된 직후 처방률이 시계열적으로 상승하였으며, 이는 처방 행태에 정책 요인이 중요한 영향을 미칠 수 있음을 뜻한다.

Citations

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Measurement of Ambulatory Medication Errors in Children: A Scoping Review
Lisa Rickey, Katherine Auger, Maria T. Britto, Isabelle Rodgers, Shayna Field, Alayna Odom, Madison Lehr, Alexandria Cronin, Kathleen E. Walsh
Pediatrics.2023;[Epub] CrossRef
Trends and Patterns of Systemic Glucocorticoid Prescription in Primary Care Institutions in Southwest China, from 2018 to 2021
Xiaoyi Li, Zhen Zeng, Xingying Fan, Wenju Wang, Xiaobo Luo, Junli Yang, Yue Chang
Risk Management and Healthcare Policy.2023; Volume 16: 2849. CrossRef
Effects of monthly evaluations on the rates of irrational antimicrobial prescription in the outpatient and emergency departments at Ningbo No. 6 Hospital, Ningbo, China
Qiong Yang, Fangfang Yuan, Li Li, Jianfeng Jin, Junhong He
European Journal of Medical Research.2022;[Epub] CrossRef
Systemic glucocorticoid prescriptions pattern and factors of inappropriate use in primary care institutions of Southwest China
Xiaobo Luo, Shitao Yu, Zhen Zeng, Xunrong Zhou, Yuxi Liu, Lei Wang, Jiaqi Hu, Yue Chang
Frontiers in Public Health.2022;[Epub] CrossRef
Effects of Antiviral Therapy and Glucocorticoid Therapy on Fever Duration in Pediatric Patients with Influenza
Ji Yoon Han, Eun Ae Yang, Jung-Woo Rhim, Seung Beom Han
Medicina.2021; 57(12): 1385. CrossRef

The Impact of an Emergency Fee Increase on the Composition of Patients Visiting Emergency Departments: Hyemin Jung, Young Kyung Do, Yoon Kim, Junsoo Ro; J Prev Med Public Health. 2014;47(6):309-316. Published online November 24, 2014; DOI: https://doi.org/10.3961/jpmph.14.044

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Abstract PDF: Objectives
This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits.
Methods
We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions.
Results
The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes.
Conclusions
A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.; Summary

English Abstract

Strengthening Causal Inference in Studies using Non-experimental Data: An Application of Propensity Score and Instrumental Variable Methods.: Myoung Hee Kim, Young Kyung Do; J Prev Med Public Health. 2007;40(6):495-504.; DOI: https://doi.org/10.3961/jpmph.2007.40.6.495

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Abstract PDF

OBJECTIVES
This study attempts to show how studies using non-experimental data can strengthen causal inferences by applying propensity score and instrumental variable methods based on the counterfactual framework. For illustrative purposes, we examine the effect of having private health insurance on the probability of experiencing at least one hospital admission in the previous year. METHODS: Using data from the 4th wave of the Korea Labor and Income Panel Study, we compared the results obtained using propensity score and instrumental variable methods with those from conventional logistic and linear regression models, respectively. RESULTS: While conventional multiple regression analyses fail to identify the effect, the results estimated using propensity score and instrumental variable methods suggest that having private health insurance has positive and statistically significant effects on hospital admission. CONCLUSIONS: This study demonstrates that propensity score and instrumental variable methods provide potentially useful alternatives to conventional regression approaches in making causal inferences using non-experimental data.

Summary

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Association between private health insurance and medical use by linking subjective health and chronic diseases
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Original Article

Disability Weights for the Korean Burden of Disease Study: Focused on Comparison with Disability Weights in the Australian Burden of Disease Study.: Young Kyung Do, Seok Jun Yoon, Jung Kyu Lee, Young Hoon Kwon, Sang Il Lee, Changyup Kim, Kidong Park, Yong Ik Kim, Youngsoo Shin; J Prev Med Public Health. 2004;37(1):59-71.

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Abstract PDF: OBJECTIVE
This study aimed to measure the disability weights for the Korean Burden of Disease study, and to compare them with those adopted in the Australian study to examine the validity and describe the distinctive features. METHODS: The standardized valuation protocol was developed from the Global Burden of Disease (GBD) study and the Dutch Disability Weights study. Disability weights were measured for 123 diseases of the Korean version of Disease Classification by three panels of 10 medical doctors each. Then, overall distribution, correlation coefficients, difference by each disease, and mean of differences by disease group were analyzed for comparison of disability weights between the Korean and Australian studies. RESULTS: Korean disability weights ranged from 0.037 to 0.927. While the rank correlation coefficient was moderate to high (rs=0.68), Korean disability weights were higher than the corresponding Australian ones in 79.7% of the 118 diseases. Of these, war, leprosy, and most injuries showed the biggest differences. On the contrary, many infectious and parasitic diseases comprised the greater part of diseases of which Korean disability weights were lower. The mean of the differences was the highest in injuries of GBD disease groups, and in cardiovascular disease, injuries, and malignant neoplasm of the Korean disease category. CONCLUSION: Korean disability weights were found to be valid on the basis of overall distribution pattern and correlation, and are expected to be used as basic data for broadening the scope of burden of disease study. However, some distinctive features still remain to be explored in following studies.; Summary

Comparative Study

Disability Weights for Diseases in Korea.: Jung Kyu Lee, Seok Jun Yoon, Young Kyung Do, Young Hoon Kwon, Chang Yup Kim, Kidong Park, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 2003;36(2):163-170.

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Abstract PDF: OBJECTIVES
This study aimed to develop an evaluation protocol of disability weights using person trade-off, and to test the reliability of the developed protocol in a Korean context. METHODS: To develop the valuation protocol, the Global Burden of Disease (GBD) and the Dutch studies were replicated and modified. Sixteen indicator conditions were selected from the Korean version of disease classification, which was based on that of the GBD Study, and the person trade-off method referred to the Dutch method. RESULTS: The disability weights were valued in a two step panel study. The first step was a carefully designed group process by three panels, using person trade-off to establish the disability weights for sixteen selected indicator conditions. The second step consisted of interpolation of the remaining diseases, on a disability scale, by the individual members of three panels. The members of three panels were all medical doctors, with sufficient knowledge of the consequences of a broad variety of diseases. The internal consistency of the Korean disability weights was satisfactory. Considerable agreement existed within each panel and among the panels. CONCLUSIONS: It was feasible to use a modified evaluation protocol from those used in GBD and Dutch studies. This would provide a rational basis for an international comparative study of disability weights.; Summary

Original Article

Study of Disability-Adjusted Life Expectancy(DALE) Using National Health Interview Survey in Korea.: Young Hoon Kwon, Jung Kyu Lee, Young Kyung Do, Seok Jun Yoon, Chang Yup Kim, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 2002;35(4):331-339.

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Abstract PDF: OBJECTIVES
To measure DALE (Disability-Adjusted Life Expectancy) in Korea to find out how long Koreans live in a state of full heath. METHODS: DALE was calculated using the life table of 1999 and the disability prevalence from the National Health Interview Survey (NHIS), which was conducted with a sample of 13,523 households in 1998. The disability prevalence was measured using the annual prevalence of the long-term limitation of activities, which were divided into classes 1, 2, 3, 4, 5 and 6 according to the severity of the limitation. The disability weights were measured for each 6 class by conducting a survey of 16 healthcare professionals. The severity-adjusted disability prevalence was calculated by multiplying the disability prevalence of each class by the disability weights respectively. Healthy life years lost due to disability was calculated by multiplying the life expectancy by the severity-adjusted disability prevalence. Finally DALE was measured as the life expectancy minus healthy life years lost due to disability. RESUJLTS: DALE for 1999, which refers to the expectation of equivalent years of good health, were 72.5, 69.5 and 75.3 years, for total, for males and for females, respectively. The percentages for DALE out of the life expectancy were 95.8, 96.6 and 94.4% for total, for males and for females, respectively. CONCLUSIONS: DALE is a newly developed indicator, which could effectively show the healthy life expectancy of populations. A greater notice and use of DALE would be expected as life expectancies increase and the quality of life changes in Korea.; Summary

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