Journal of Preventive Medicine and Public Health

Original Articles

Evaluation of Geographic Indices Describing Health Care Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Yoon Kim; J Prev Med Public Health. 2017;50(1):29-37. Published online December 19, 2016; DOI: https://doi.org/10.3961/jpmph.16.099

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Objectives
The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization.
Methods
We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates.
Results
In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index.
Conclusions
Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

Summary

Citations

Citations to this article as recorded by

Factors Associated with End-Of-Life Health Care Use and Spending in Korea in Comparison with the General Population
Agnus M. Kim, Yoon Kim
Journal of Aging & Social Policy.2024; 36(5): 829. CrossRef
Development and Evaluation of Rehabilitation Service Areas for the United States
Timothy A. Reistetter, Julianna M. Dean, Allen M. Haas, John D. Prochaska, Daniel C. Jupiter, Karl Eschbach, Yong-Fang Kuo
BMC Health Services Research.2023;[Epub] CrossRef
Presence of Thrombectomy-capable Stroke Centers Within Hospital Service Areas Explains Regional Variation in the Case Fatality Rate of Acute Ischemic Stroke in Korea
Eun Hye Park, Yong Jin Gil, Chanki Kim, Beom Joon Kim, Seung-sik Hwang
Journal of Preventive Medicine and Public Health.2021; 54(6): 385. CrossRef
An ecological study of geographic variation and factors associated with cesarean section rates in South Korea
Agnus M. Kim, Jong Heon Park, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Pregnancy and Childbirth.2019;[Epub] CrossRef
Geographic variation and factors associated with rates of knee arthroplasty in Korea-a population based ecological study
Agnus M. Kim, Sungchan Kang, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Musculoskeletal Disorders.2019;[Epub] CrossRef
Factors associated with the rates of coronary artery bypass graft and percutaneous coronary intervention
Agnus M. Kim, Jong Heon Park, Seongcheol Cho, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Cardiovascular Disorders.2019;[Epub] CrossRef

The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Kyosang Hwang, Taesik Lee, Yoon Kim; J Prev Med Public Health. 2016;49(4):230-239. Published online July 14, 2016; DOI: https://doi.org/10.3961/jpmph.16.034

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161 Download
18 Crossref

Abstract PDF Supplementary Material

Objectives
We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts) and new areal units organized based on the actual health care use of the population in Korea.
Methods
To compare geographic variation in geographic units of analysis, we calculated the age–sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan) from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units.
Results
Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures.
Conclusions
Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.

Summary

Citations

Citations to this article as recorded by

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In Gyu Song, You Sun Kim, Min Sun Kim, Ji Weon Lee, Yoon-Min Cho, Youna Lim, Seong Keun Kwon, Dong In Suh, June Dong Park
BMJ Paediatrics Open.2024; 8(1): e002377. CrossRef
Geographic Distribution of Central Nervous System Rehabilitation Treatment in Korea and Its Associated Factors
Dong-Gyun Sohn, Jaehong Yoon, Jun-Soo Ro, Ja-Ho Leigh
Journal of Korean Medical Science.2023;[Epub] CrossRef
Defining Referral Regions for Inpatient Trauma Care: The Utility of a Novel Geographic Definition
Cheryl K. Zogg, Robert D. Becher, Michael K. Dalton, Sameer A. Hirji, Kimberly A. Davis, Ali Salim, Zara Cooper, Molly P. Jarman
Journal of Surgical Research.2022; 275: 115. CrossRef
High Level of Unwarranted Clinical Variation in the Use of Lower Extremity Revascularisation Procedures in Hungary (2013–2017)
Endre Kolossváry, Tamás Ferenci, Tamás Kováts, Péter Sótonyi, Zoltán Szeberin, Balázs Nemes, Edit Dósa, Katalin Farkas, Zoltán Járai
European Journal of Vascular and Endovascular Surgery.2022; 63(6): 874. CrossRef
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Cho Hee Kim, In Gyu Song, Min Sun Kim, Jin Yong Lee, Nam Gu Lim, Hee Young Shin
Scientific Reports.2020;[Epub] CrossRef
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Agnus M. Kim, Sungchan Kang, Jong Heon Park, Yoon Kim
International Journal of Environmental Research and Public Health.2020; 17(4): 1244. CrossRef
A spatial analysis of geographic variation and factors associated with hospitalization for bacterial pneumonia in Korea
Agnus M. Kim, Sungchan Kang, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Pulmonary Medicine.2019;[Epub] CrossRef
Regional Differences in Years of Life Lost in Korea from 1997 to 2015
Dun-Sol Go, Young-Eun Kim, Munkhzul Radnaabaatar, Yunsun Jung, Jaehun Jung, Seok-Jun Yoon
Journal of Korean Medical Science.2019;[Epub] CrossRef
Hospitalizations for ambulatory care sensitive conditions as an indicator of access to primary care and excess of bed supply
Agnus M. Kim, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Health Services Research.2019;[Epub] CrossRef
An ecological study of geographic variation and factors associated with cesarean section rates in South Korea
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BMC Pregnancy and Childbirth.2019;[Epub] CrossRef
Geographic variation and factors associated with rates of knee arthroplasty in Korea-a population based ecological study
Agnus M. Kim, Sungchan Kang, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Musculoskeletal Disorders.2019;[Epub] CrossRef
Factors associated with the rates of coronary artery bypass graft and percutaneous coronary intervention
Agnus M. Kim, Jong Heon Park, Seongcheol Cho, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Cardiovascular Disorders.2019;[Epub] CrossRef
Geographic variation in health insurance benefits in Qianjiang District, China: a cross-sectional study
Yue Wu, Liang Zhang, Xuejiao Liu, Ting Ye, Yongfei Wang
International Journal for Equity in Health.2018;[Epub] CrossRef
Epidemiology of pathogens and antimicrobial resistanceof catheter-associated urinary tract infections in intensivecare units: A systematic review and meta-analysis
Dan Peng, Xuan Li, Pin Liu, Mei Luo, Shuai Chen, Kewen Su, Zhongshuang Zhang, Qiang He, Jingfu Qiu, Yingli Li
American Journal of Infection Control.2018; 46(12): e81. CrossRef
Regional variation in healthcare spending and mortality among senior high-cost healthcare users in Ontario, Canada: a retrospective matched cohort study
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BMC Geriatrics.2018;[Epub] CrossRef
Regional Differences in Years of Life Lost in Korea from 1997 to 2015
Dun-Sol Go, Young-Eun Kim, Munkhzul Radnaabaatar, Yunsun Jung, Jaehun Jung, Seok-Jun Yoon
Journal of Korean Medical Science.2018;[Epub] CrossRef
A framework for the identification and classification of homogeneous socioeconomic areas in the analysis of health care variation
Ludovico Pinzari, Soumya Mazumdar, Federico Girosi
International Journal of Health Geographics.2018;[Epub] CrossRef
Senior high-cost healthcare users’ resource utilization and outcomes: a protocol of a retrospective matched cohort study in Canada
Sergei Muratov, Justin Lee, Anne Holbrook, J Michael Paterson, Jason Robert Guertin, Lawrence Mbuagbaw, Tara Gomes, Wayne Khuu, Priscila Pequeno, Andrew P Costa, Jean-Eric Tarride
BMJ Open.2017; 7(12): e018488. CrossRef

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