- Inter-hospital Comparison of Cesarean Section Rates after Risk Adjustment.
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Sang Il Lee, Young Ho Khang, Beom Man Ha, Moo Song Lee, Weechang Kang, Hee Jo Koo, Chang Yup Kim
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Korean J Prev Med. 2001;34(4):337-346.
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 Abstract
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- OBJECTIVE
To determine the clinical risk factors associated with the mode of delivery decision and to compare cesarean section rates after adjusting for risk factors identified among Korean hospitals. METHODS: Data were collected from 9 general hospitals in two provincial regions by medical record abstraction during February 2000. A total of 3,467 cases were enrolled and analyzed by stepwise logistic regression. Performance of the risk-adjustment model (discrimination and calibration) was evaluated by the C statistic and the Hosmer-Lemeshow test. Crude rates, predicted rates with 95% confidence intervals, and adjusted rates of cesarean section were calculated and compared among the hospitals. RESULTS: The average crude cesarean section rate was 53.2%, ranging from 39.4% to 65.7%. Several risk factors such as maternal age, previous history of cesarean section, placenta previa, placental abruption, malpresentation, amniotic fluid abnormality, gestational anemia, infant body weight, pregnancy-induced hypertension, and chorioamnionitis were found to have statistically significant effects on the mode of delivery. It was confirmed that information about most of these risk factors was able to be collected through the national health insurance claims database in Korea. Performance of the risk-adjustment model was good (c statistic=0.815, Hosmer-Lemeshow test=0.0621). Risk factor adjustment did lead to some change in the rank of hospital cesarean section rates. The crude rates of three hospitals were beyond 95% confidence intervals of the predicted rates. CONCLUSIONS: Considering that cesarean section rates in Korean hospitals are too high, it is apparent that some policy interventions need to be introduced. The concept and methodology of risk adjustment should be used in the process of health policy development to lower the cesarean section rate in Korea.
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Summary
- Complementary and Alternative Medicine Use in Korea: Prevalence, Pattern of Use, and Out-of-pocket Expenditures.
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Sang Il Lee, Young Ho Khang, Moo Song Lee, Hee Jo Koo, Weechang Kang, Changgi D Hong
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Korean J Prev Med. 1999;32(4):546-555.
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Abstract
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- OBJECTIVES
To determine the prevalence, pattern, and out-of-pocket expenditure of complementary and alternative medicine (CAM) utilization in Korean adult population. METHODS: We conducted a representative telephone survey of 2,042 persons aged 18 or older. Data about any health problem, details of their use of medical doctors(MDs) offices/hospitals/ pharmacies services and CAM during the preceding 12 months were collected with structured questionnaire. RESULTS: The utilization rate of CAM among Korean adults was 29% in one year. A total of 231 kinds of CAM was identified from this survey. Annual out-of-pocket expenditure associated with CAM use in 1998 amounted to pound $1.88 billion and was comparable to 40.8% of out-of-pocket expenditure paid for MDs offices/ hospitals/pharmacies services. Among those(N=424) who paid for both MDs offices/hospitals/pharmacies services and CAM, 35.8% paid more for CAM. CAM gave more satisfaction than western medicine to those who had experience of both types of therapy. About half of CAM users were willing to recommend CAM to others. Disclosure rate to physician among CAM users was not high(40.6%). CONCLUSION: CAM became a popular source of health care in Korea. Korean spent a substantial amount of out-of-pocket money on CAM without any public control. Because CAM use is likely to be increased rapidly through lay referral system, health policy makers and health professionals should pay more attention to CAM for making appropriate utilization of CAM.
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KSPM
