Journal of Preventive Medicine and Public Health

Volume 38(1); February 2005

English Abstracts

Factors Influencing Antibiotics Prescribing of Primary Health Physicians in Acute Upper Respiratory Infections.: Nam Soon Kim, Soong Nang Jang, Sun Mee Jang; J Prev Med Public Health. 2005;38(1):1-8.

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Abstract PDF: OBJECTIVES
To explore the factors influencing antibiotics prescription by primary health physicians for acute upper respiratory infections (URI). METHODS: We performed a survey of 370 primary health physicians randomly sampled in April, 2003. The questionnaire consisted of a prescription on the scenario of acute bronchitis case, along with opinions and reasons for prescribing antibiotics on URI. RESULTS: We found that 54.7% of the physicians prescribed antibiotics on the example case of acute bronchitis which is known as not needing antibiotics. Female physicians and ENT physicians had a greater tendency to prescribe antibiotics. The factors influencing antibiotics prescription on URI were the belief about the effectiveness of antibiotics, preference for their own experiences rather than clinical guidelines, perception of patients' expectations, and perception of competitive environment. The prescription of antibiotics in the example case was affected by how much they usually prescribe antibiotics (OR=2.400, 95% CI=1.470-3.917) and the physicians who thought that antibiotics were helpful for their income prescribed antibiotics more than others (OR=6.773, 95% CI=1.816-25.254). CONCLUSION: These findings demonstrated that the false belief on the effectiveness of antibiotics, patient's expectation of medication and fast relief of symptoms, and perception of competitive environment all affected the physicians' prescription of antibiotics on URI. It may help to find barriers to accommodate scientific evidence and clinical guidelines among physicians and to specify subgroups for education about appropriate prescription behaviors.; Summary

Medical Expenses by Site of Cancer and Survival Time among Cancer Patients in the Last One Year of Life.: Jee Jeon Yi, Won Kon Yoo, So Yoon Kim, Kwang Ki Kim, Sang Wook Yi; J Prev Med Public Health. 2005;38(1):9-15.

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Abstract PDF: OBJECTIVES
To analyze medical expenses by cancer site and survival time among cancer patients in their last year of life. METHOD: The study subjects were 45, 394 people that had died of cancers in 2002, were registered by the Korea Central Cancer Registry and received National Health Insurance benefit in the last year (360 days) of life. Personal identification data, general characteristics, dates of death and cancer incidence, and site of cancer were collected from the National Statistical Office and the Korea Central Cancer Registry, and merged with the data of the individual medical expenses of the Health Insurance Review Agency. RESULTS: Average monthly cost curves were U-shaped with high costs near the time of diagnosis and death, and lower costs in between. Medical expenses in the last year of life were around 30.3, 16.7, 13.0, and 12.1 million won among leukemia, lymphoma, ovarian cancer, and breast cancer patients, respectively. Digestive organ cancers including stomach, esophagus, liver, pancreas, and colorectal cancers had relatively low medical expenses. Medical expenses in the last year of life were inverse U-shaped with high expenses near one year of survival. Average monthly cost in the 12 months before death among the patients who had survived 10~15 years were more than two-fold greater than the cost before diagnosis among those who had survived for less than one year. CONCLUSIONS: Leukemia was the most expensive cancer. It is possible that once diagnosed as cancer, medical expenses do not return to the level before diagnosis. Further research will be needed to understand the magnitude and change of the medical expenses among cancer patients with long term follow up data.; Summary

Determining Factors of Intention to Actual Use of Charged Long-term Care Services for the Aged.: Jin Yeong Yoo, Jin Ho Chun; J Prev Med Public Health. 2005;38(1):16-24.

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Abstract PDF: OBJECTIVES
To help develop strategies to cope with the changes arising from the rapid aging process by predicting the determining factors of intention to actual use of the charged long-term care services for elderly as perceived by the middle aged who play the major role of supports. METHODS: Subjects were the parents (men 177, women 507) in their 40s of the students selected from a university of Busan city. A questionnaire survey was conducted for 4 weeks in October 2003 about the knowledge for long-term care service, the intention of actual use, and the preferences about the type of service suppliers. Data analysis was performed with frequency, chi-square test, and t-test using SPSS program (ver 10.0K), along with data mining using decision tree of Enterprise Miner V8.2 by SAS. RESULTS: About half of the subjects (53.7%) had the actual experiences of elderly supports. Intentions to use the charged services were relatively high in home visiting nursing care service (40.1%) and long-term care facilities service (40.4%), and were influenced by previous knowledge about the services. The intentions were stronger in women, those with higher education, and those with greater income levels. Actual elderly supports were mostly (80%) done by women, and the perceived burdens for the supports were bigger in women and those of lower socio-economic level. Desired charges were about 10, 000 won for the bath service, 20, 000 won for the rests services per day, and about 500, 000 won for the long-term care facilities service per month. From the result of decision tree analysis, the job professionalism was the most important determining factor of intention to actual use of the services with validation as 63~71%. Health and welfare mixed type facilities were preferred, and the most important consideration was the level of professionalism. CONCLUSIONS: Intention to actual use of the charged services was largely determined by the aspects of time and cost. Polices to increase the number of service suppliers and to decrease the burdens perceived by actual supporters were strongly recommended.; Summary

Epidemiology of Psychosocial Distress in Korean Employees.: Sei Jin Chang, Sang Baek Koh, Myung Gun Kang, Bong Suk Cha, Jong Ku Park, Sook Jung Hyun, Jun Ho Park, Seong Ah Kim, Dong Mug Kang, Seong Sil Chang, Kyung Jae Lee, Eun Hee Ha, Mina Ha, Jong Min Woo, Jung Jin Cho, Hyeong Su Kim, Jung Sun Park; J Prev Med Public Health. 2005;38(1):25-37.

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Abstract PDF: OBJECTIVE
To estimate the magnitude of psychosocial distress and examine eligible factors associated with the development of psychosocial distress in Korean employees, using a nationwide sample. METHODS: A total of 6, 977 workers were recruited from 245 companies. A structured questionnaire was used to assess sociodemographics, health-related behaviors, job characteristics, social support at work, personality traits (locus of control, type A behavior pattern), self-esteem, and psychosocial distress. RESULTS: The results showed that 23 % of workers were categorized as high stress, 73% as moderate, and 5% as normal. Hierarchical multiple regression analysis showed that psychosocial distress was more common in younger workers, both male and female. Regular exercise was negatively associated with increase of psychosocial distress. In job characteristics, as expected, low decision latitude, high job insecurity, and low social support at work were related to high psychosocial distress. Personality traits such as locus of control and type A behavior pattern, and self-esteem were more powerful predictors of psychosocial distress than general characteristics, health-related behavior, and job characteristics. There were some gender differences. While men who are less educated and single (unmarried, divorced, and separated) experienced higher levels of psychosocial distress than those who are educated and married, women who feel high job demand experienced higher levels of psychosocial distress than those who feel low job demand. CONCLUSIONS: The proportion of the high stress group was higher than expected, and psychosocial factors like social support and personality characteristics (e. g. locus of control, type A behavior pattern and self-esteem) were more significant factors for psychosocial distress than other variables. This finding suggests that some psychosocial factors, especially inadequate social support, low self-esteem and lack of internal locus of control for the development of psychosocial distress, will also operate as an intervention strategy in the worksite stress reduction program. It is strongly required that worksite stress reduction programs should be established in at both occupational and level as well as in individual levels.; Summary

Mortality among Medical Doctors Based on the Registered Cause of Death in Korea 1992-2002.: You Cheol Shin, Jae Heon Kang, Cheol Hwan Kim; J Prev Med Public Health. 2005;38(1):38-44.

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Abstract PDF: OBJECTIVE
To compare the mortality rate of Korean medical doctors to that of the general Korean population for the period 1992-2002. METHODS: The membership records of the Korean Medical Association were linked to the 1992-2002 death certificate data of Korea's National Statistical Office using 13-digit unique personal identification numbers. The study population consisted of 61, 164 medical doctors with a follow-up period of 473, 932 person-years. Standardized mortality ratios (SMRs) were calculated to compare cause-specific mortality rates of medical doctors to those of the general population. RESULTS: We confirmed 1, 150 deaths at ages from 30 to 75 years from 1 January 1992 to 31 December 2002. The SMR for all-cause of death was 0.47 (95% CI : 0.44~0.50). The SMRs for smoking-related diseases such as cerebrovascular accidents and chronic obstructive pulmonary disease were smaller than the SMR of all-cause of death. However, the SMRs for colorectal and pancreatic cancers were not significantly lower than those of the general population. Transport accidents and suicides accounted for 72% (94 of 131) of external causes of death. The SMR for suicide was 0.51 (95% CI : 0.38~0.68). CONCLUSIONS: The mortality rate of South Korean medical doctors was less than 50% that of the general population of South Korea. Cause-specific analysis showed that mortality rates in leading causes of death were lower among medical doctors although differences in mortality rates between medical doctors and the general population varied with the causes of death. These health benefits found among medical doctors may be attributable to the lower level of health damaging behaviors (e.g., lower smoking rates) and better working conditions.; Summary

Fatigue Subjective Symptoms and Risk Factors in Bank Workers with VDT.: Joo Ja Kim, Kyung Jae Lee; J Prev Med Public Health. 2005;38(1):45-52.

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Abstract PDF: OBJECTIVES
To investigate the fatigue subjective symptoms and VDT related risk factors in bank workers. METHODS: A total of 2178 workers (62.8% male, 37.2% female) were surveyed with a self-administered and structured questionnaire consisting of 30 fatigue symptoms and other VDT related factors regarding work characteristics, work postures, work environments, personal medical histories, etc. Fatigue subjective symptoms were divided into 3 groups of 10 questions each: a dull, drowsy and exhausted feeling (Group I), a mental decline of working motivation (Group II), or a feeling of incongruity in the body and dysfunction of autonomic nervous system (Group III). Each question was weighted as 0 for 'none', 1 for 'sometimes', and 2 for 'always'. RESULTS: Mean age was 35.8+/-7.2 years (38.9+/-6.0 in males, 30.6+/-5.8 in females), Mean work duration was 7.7+/-7.1 years (8.4+/-7.4 in males, 6.5+/-6.4 in females). Mean symptom score in males was 11.0+/-8.1 (4.9+/-3.1 in Group I, 3.0+/-3.1 in Group II, 3.1+/-2.8 in Group III) and in females was 17.5+/-9.5 (7.0+/-3.8 in Group I, 4.6+/-3.5 in Group II, 5.9+/-3.4 in Group III). Mean scores were higher in the order of Group I> III> II. Females had significantly higher scores than males in all three groups (p< 0.001). Most common symptoms complained of as 'always' or 'sometimes' were 'feel strained in the eyes' (85.4%) among Group I, 'find difficulty in thinking' (54.2%) among Group II, and 'feel stiff in the shoulders' (72.3%) among Group III. In multiple regression analysis, female, non-straight spine at workstation, more VDT work hours, history of physical therapy, glare of screen, overtime work, young age, and non-horizontal elbow position were significantly related with high score of symptoms. CONCLUSIONS: More supportive VDT work environment and education for correct work postures for VDT workers are recommended.; Summary

Association of Internet Addiction with Health Promotion Lifestyle Profile and Perceived Health Status in Adolescents.: Jung Sook Kim, Byung Chul Chun; J Prev Med Public Health. 2005;38(1):53-60.

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Abstract PDF: OBJECTIVES
To identify the relationship between the internet addiction of adolescents and their Health Promotion Lifestyle Profile and Perceived Health Status, and thereby to detect the impact of internet addiction on the health of adolescents, produce the basic information necessary to develop a prevention program for internet addiction and to plan for a health promotion program. METHODS: This study was designed as a cross-sectional study, and the subjects were the second-grade students of three junior-high and three high schools located in the city of K in Kyung Gi Province. Out of 769 subjects, 764 completed the questionnaires (99.3%) ; 369 (48.3%) junior-high school students and 395 (51.7%) high school students. The questionnaires were composed of Young's Internet Addiction, Health Promotion Lifestyle Profile, Perceived Health Status, and general characteristics. We used t-test, ANOVA in means comparison between groups, X2-test in frequency analysis, and multiple regression analysis in multivariate analysis, using the SAS 8.1 (R) program. RESULTS: There was a statistically significant difference in Health Promotion Lifestyle Profile according to internet addiction status (severe addiction vs. other status, p< 0.0001). The Perceived Health Status scores was lowest in the severe addiction group (p< 0.001). There was also a significant negative correlation between internet addiction and Health Promotion Lifestyle Profile (p< 0.0001). The results of multiple regression showed that Young's Addiction Score was significant for the subjects' Health Promotion Lifestyle Profile after controlling for other variables (p< 0.0001). CONCLUSIONS: This study showed that the severe internet addiction group had the lowest score in Health Promotion Lifestyle Profile and Perceived Health Status, which suggests that the addiction could have a negative effect on the health status of adolescents.; Summary

Development of Measurement Scale for the Quality of Life in Hypertensive Patients.: Keon Yeop Kim, Byung Yeol Chun, Sin Kam, Sang Won Lee, Ki Soo Park, Shung Chull Chae; J Prev Med Public Health. 2005;38(1):61-70.

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Abstract PDF: OBJECTIVES
To develop a tool for multidimensional measurement of the quality of life, which was psychometrically sound, short, and easy to administer for patients with hypertension. METHODS: A sample of 1, 115 hypertensive patients aged 20 or above in Cheong-Song County was studied from June 1997 to October 1998. In the development of the instrumental stage, the authors first conceptualized the quality of life. Item generation, item reduction, and questionnaire formatting were followed. Item-level (item descriptive, missing%, item internal consistency, item discriminant validity) analysis, scale-level (scale descriptive, floor and ceiling effect) analysis, and other tests (Cronbach's alpha, inter-dimension correlations, factor analysis, clinical validity) were performed to evaluate the validity and reliability of the new measurement scale. After 1 year, responsiveness and confirmatory factor analysis were performed. RESULTS: The results of both item-level and scale-level analyses were acceptable. An acceptable degree of internal consistency was observed for each of the dimensions (Cronbach's alpha was 0.60 or higher). Inter-dimension correlations were below 0.50 and the factor analysis result was the same as the intended dimension structure. Correlation coefficients between perceived health status, stress and dimensions were proven to be acceptable. The result of comparing dimensional score means among ADL and MMSE-K groups above 60 years was statistically significant (p< 0.05). The result of confirmatory factor analysis concluded that the dimensional structure model was well fitted. However, the result of responsiveness test using sensitivity and specificity was unsatisfactory. CONCLUSIONS: The newly developed measurement scale is psychometrically reliable and valid instrument for measuring quality of life in hypertensive patients.; Summary

Correlates of Self-rated Fatigue in Korean Employees.: Sei Jin Chang, Sang Baek Koh, Myung Gun Kang, Sook Jung Hyun, Bong Suk Cha, Jong Ku Park, Jun Ho Park, Seong Ah Kim, Dong Mug Kang, Seong Sil Chang, Kyung Jae Lee, Eun Hee Ha, Mina Ha, Jong Min Woo, Jung Jin Cho, Hyeong Su Kim, Jung Sun Park; J Prev Med Public Health. 2005;38(1):71-81.

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Abstract PDF: OBJECTIVE
To elucidate the correlates of self-rated fatigue in Korean employees. METHODS: The data for 10, 176 (men, 7, 984; women, 2, 192; mean age, 34.2; SD: 8.8) employees recruited from a nationwide sample were examined. A structured questionnaire was used to measure the participants' fatigue, sociodemographics (sex, age, education, and marital status), job-related characteristics (work duration, grade at work, work hours, shiftwork, employment type, and magnitude of workplace), and health-related habits (smoking, drinking, coffee intake, and exercise). Two types of measurement for fatigue were used to evaluate the magnitude of fatigue: self-rated question and a standardized measurement tool (Multidimensional Fatigue Scale: MFS). RESULTS: According to the self-rated fatigue, 32% of employees reported that they felt fatigue for the past two weeks, and 9.6% of males and 8.7% of females had experienced excessive fatigue (6 months or more). Hierarchical multiple regression analysis showed that fatigue measured by MFS was more common in women, younger, college or more graduated, single, and employees who do not regularly exercise. Fatigue was also associated with long work hours, and the size of the workplace (< 1, 000 employees). CONCLUSIONS: These results suggest that fatigue has been considered as a common complaint, and that it is affected by job-related factors like work hours and the workplace size as well as sociodemographics or health-related behaviors. Further research is needed to clarify the effects of fatigue on adverse health outcomes, work performance, work disability, sick absence and medical utilization, and to examine the relationship of job characteristics (e.g.: work demand, decision latitude) to fatigue.; Summary

Analysis of Behavioral Stage in Pap Testing by Using Transtheoretical Model.: Hye Jean Lee, Sun Hee Lee, Sang Hyuk Jung, Hai Rim Shin, Dae Kyu Oh; J Prev Med Public Health. 2005;38(1):82-92.

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Abstract PDF: OBJECTIVE
To evaluate the relationships among sociodemographic characteristics, health behaviors, levels of pros and cons and stages of change in Pap testing for uterine cervical cancer. METHODS: A questionnaire survey was performed on 560 randomly sampled people who were assigned to participate in a Pap testing program by the 'National Cancer Screening Project in 2003' between 25 September and 10 October in Gyeonggi, Korea. Data about the behaviors and intentions of Pap testing, sociodemographic characteristics, health behaviors, and levels of acknowledged benefit (pros) and barrier (cons) for Pap testing was collected. The stages of change were grouped according to behaviors and intentions of Pap testing as passive, active, and relapse. RESULTS: Logistic analysis between the passive and active groups showed that city dwellers, 'high' and 'middle' groups in terms of the individual's health belief, those who had undergone a health examination within the past 2 years, and those who had undergone hormone replacement therapy had a higher odds ratios to be in the active group. As the 'benefit' scores increased and the 'Unnecessity' scores decreased, the probabilities to be in the active group increased. According to the logistic analysis results between the active and relapse groups, those who were 60 years or older, members of the National Heath Insurance, and those who had not undergone a health examination within the past 2 years had a higher odds ratio to be in the relapse group. The 'Benefit' scores were not significant in this relationship. The probabilities of being in the relapse group increased as the 'Unnecessity' and 'Shamefulness' scores increased. CONCLUSIONS: In conclusion, health planners should inform women in the passive group of the benefits and necessity of Pap testing. It would be better to reduce the barriers to the active group of undergoing Pap smear. This study might be a useful guide for future planning of Pap testing program.; Summary

Participation Rate and Related Socio-demographic Factors in the National Cancer Screening Program.: Na Young Sung, Eun Cheol Park, Hai Rim Shin, Kui Son Choi; J Prev Med Public Health. 2005;38(1):93-100.

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Abstract PDF: BACKGROUND
Cancer is the leading cause of death and one of the largest burdens of disease in Korea. In 1996, the 'Ten year Plan for Cancer Control' was formulated and the government then adopted the plan as a national policy. As part of this plan, the National Cancer Screening Program (NCSP) for Medicaid recipients was formulated, and the government adapted this in 1999. For low-income beneficiaries of the National Health Insurance Corporation (NHIC), the screening program has been in place since 2002. In 2002, the target cancers of NCSP were stomach, breast and cervical cancer. This study was conducted to examine the relationships between the participation rate, the abnormal screening rate and the socio-demographic factors associated with participation in the screening program. METHODS: To analyze the participation rate and abnormal rate for the NCSP, we used the 2002 NCSP records. The information on the socio-demographic factors was available from the database of the beneficiaries in the NHIC and Medicaid. RESULTS: The participation rate of the Medicaid beneficiaries for the stomach, breast and cervical cancer screening were 9.2%, 15.5% and 15.0%, respectively, and 11.3% and 12.5%, except cervical cancer which wasn't be included in the NCSP, for the beneficiaries of the NHIC. The abnormal rate of stomach, breast and cervical cancer screening were 25.7%, 11.2% and 21.0%, respectively, for the beneficiaries of Medicaid and 42.6% and 19.4% for the beneficiaries of the NHIC. On the multiple logistic regression analysis, gender, age and place of residence were significantly associated with participation rates of the NCSP. For stomach cancer, women participated in the NCSP more than men. The participation rate was higher among people in their fifties and sixties than for those people in their forties and those people over seventy years in age. For the breast and cervical cancer, people in their fifties were more likely to participate in the NCSP than people in their forties and people over sixty. For the place of residence, people in the rural areas participated more than those people in any other places. CONCLUSIONS: The above results show that the participation rate and abnormal rate were significantly associated with the socio-demographic factors. To improve the participation rate for the NCSP, more attention should be given to the underserved groups.; Summary

The Association between Serum GGT Level within Normal Range and Risk Factors of Cardiovascular Diseases.: Ji Seun Lim, Yu Jin Kim, Byung Yeol Chun, Jin Hoon Yang, Duk Hee Lee, Sin Kam; J Prev Med Public Health. 2005;38(1):101-106.

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Abstract PDF: OBJECTIVES
We conducted this study to examine the association between serum GGT levels within the normal range and the risk factors of cardiovascular diseases METHODS: We examined the cross-sectional association between serum GGT and the systolic and diastolic blood pressure, fasting blood glucose, total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-cholesterol), and uric acid among 975 subjects that participated in the health examination of a university hospital located in Daegu city. All the patients' GGT levels were within the normal range. RESULTS: After adjustment were made for age, body mass index (BMI), smoking status, drinking frequency, exercise frequency and coffee intake, the serum GGT level was positively associated with fasting blood glucose (p< 0.01), total cholesterol (p< 0.01), and triglyceride (p< 0.01) in men, and it was positively associated with fasting blood glucose (p< 0.01), total cholesterol (p< 0.05), triglyceride (p< 0.01), and uric acid (p< 0.01) in women. The associations were not significantly different depending on the status of alcohol drinking or obesity, except for the associations of serum GGT with diastolic blood pressure (P for interaction=0.04) and uric acid (P for interaction=0.04) between the lean and obese subjects. CONCLUSIONS: Serum GGT levels within the normal range were positively associated with fasting blood glucose, triglyceride and uric acid in most subgroups irrespective of the drinking or obesity status. These results suggest that GGT has important clinical implications as being more than just a marker of alcohol consumption and hepatobiliary disease.; Summary

Changes in Distributive Equity of Health Insurance Contribution Burden.: Hee Chung Kang, Eun Cheol Park, Kyu Sik Lee, Tae Kyu Park, Woo Jin Chung, Han Joong Kim; J Prev Med Public Health. 2005;38(1):107-116.

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Abstract PDF: OBJECTIVES
We analyzed the changes from 1996 to 2002 in distributive equity of the contribution burden in the Korean National Health Insurance. METHODS: The study subjects were a total of 8, 923 employee households and a total of 7, 296 self-employed households over the period from 1996 to 2002. Those were the households meeting the two criteria as completing each annual survey and having no change in the job of head of the household during that period from the raw data of the Household Income and Expenditure Survey annually conducted by the Korean National Statistical Office. The unit of analysis was a household, and this was the standard for assessing the contribution that is now applied on a monthly basis. Deciles Distribution Ratio, Contribution Concentration Curve and Contribution Concentration Index were estimated as the index of inequality. Multiple regression analysis was conducted to compare the annual ability-to-pay elasticity of the contribution to the reference year of 1996 for three groups (all households, the employee households, and the self-employed households). RESULTS: For the index of inequality, the distributive equity of contribution was improved in all three groups. In particular, the employee group experienced a substantial improvement. Using multiple regression analysis, the ability-to-pay elasticity of the contribution in the employee group significantly increased ( beta=0.232, p< 0.0001) in the year 2002 as compared to the reference year of 1996. The elasticity in the self-employed group also significantly increased ( beta=0.186, p< 0.05), although its change was smaller than that in the employee group. CONCLUSIONS: The employee group had a greater improvement for the distributive equity of the contribution burden than the self-employed group. Within the observation period, there were two important integration reforms: one was the integration of 227 self-employed societies in 1998 and the other was the integration of 139 employee societies in 2000. We expected that the equity of the contribution burden would be improved for the self-employed group since the integration reform of 1998. However, it was not improved for the self-employed group until the year 2000. This result suggests that capturing exactly the beneficiaries' ability-to-pay such as income is the precedent for distributive equity of the contribution burden, although a more sophisticated imposition standard of contribution is needed.; Summary

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