- 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
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Yukyung Shin, Ji-su Lee, Young Kyung Do
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J Prev Med Public Health. 2022;55(4):389-397. Published online July 11, 2022
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DOI: https://doi.org/10.3961/jpmph.22.208
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 Abstract
Summary
 PDF Supplementary Material
- 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.
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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.
- Public Preferences for Allocation Principles for Scarce Medical Resources in the COVID-19 Pandemic in Korea: Comparisons With Ethicists’ Recommendations
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Ji-Su Lee, Soyun Kim, Young Kyung Do
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J Prev Med Public Health. 2021;54(5):360-369. Published online August 26, 2021
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DOI: https://doi.org/10.3961/jpmph.21.333
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Abstract
Summary
PDFSupplementary 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.
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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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Citations
Citations to this article as recorded by  - 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
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