Journal of Preventive Medicine and Public Health

Original Articles

Exploring the Role of Social Welfare Expenditures in Depressive Symptoms Among Older Adults in Korea: Ji-Su Lee, Eun Sil Yoon, Yeongchae Song, Seowoo Park, Young Kyung Do; J Prev Med Public Health. 2025;58(4):370-378. Published online February 18, 2025; DOI: https://doi.org/10.3961/jpmph.24.403

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Abstract Summary PDF: Objectives
This study aimed to explore the role of community-level social welfare expenditures in depressive symptoms among older adults in Korea, with a particular focus on living arrangements.
Methods
Multi-level data—comprising individual-level data from the 2019 Community Health Survey and regional-level data from the Korean Statistical Information Service—were analyzed using multi-level ordered logistic regression. The dependent variable was the severity of depressive symptoms as measured by the Patient Health Questionnaire-9 score, and the primary independent variables were per capita social welfare expenditure, living arrangements, and their cross-level interaction term.
Results
Older adults living alone exhibited more severe depressive symptoms compared to those living with others (odds ratio [OR], 1.22; p=0.006). Higher community social welfare expenditure was significantly associated with reduced depressive symptom severity (OR, 0.73; p=0.019). Moreover, the protective effect of social welfare expenditure was more pronounced among older adults living alone than among those not living alone (OR, 0.92; p=0.046). Social welfare expenditure was highly correlated with social cohesion, which weakened its independent association with depressive symptoms.
Conclusions
This study highlights the potential of community-level social welfare expenditure to mitigate depressive symptoms among older adults, particularly those who live alone. In light of the rising number of older adults living alone, these findings suggest that non-medical interventions, such as enhanced social welfare programs, may help alleviate depression in this vulnerable population. The strong positive correlation between social welfare expenditure and social cohesion also raises further research questions regarding their interrelationship.; Summary

Korean summary
자치단체의 일인당 사회복지 지출이 증가할수록 해당 지역에 거주하는 노인의 우울 증상이 전반적으로 감소하는 결과를 보였고 이러한 연관성은 특히 독거 노인에게서 더 뚜렷하게 나타났다. 이 결과는 노인인구 규모 및 독거 노인 비율의 증가가 초래할 수 있는 노인 정신 건강의 부정적 영향을 비의료적, 사회적 개입을 통해 완화할 수 있음을 시사한다.

Key Message
Higher community-level social welfare expenditure was associated with lower severity of depressive symptoms among older adults, with this association more pronounced among those living alone. Given the rising number of older adults living alone, these findings highlight the potential of non-medical, social interventions to alleviate depression in this vulnerable population.

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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2 Web of Science
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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.

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

Citations to this article as recorded by

Inter-regional patient outmigration to Seoul in South Korea: the role of regional healthcare quality perceptions
Moo Hyuk Lee, Ji-Su Lee, Young Kyung Do
BMC Health Services Research.2025;[Epub] CrossRef
Clinical Significance of Isolated Sphenoid Sinusitis Identified in Pediatric Patients Presenting with Headache
Seung Beom Han, Jee Min Kim, Eu Gene Park, Ji Yoon Han, Jin Lee
Medicina.2024; 60(10): 1625. CrossRef
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

9,139 View
204 Download
7 Web of Science
9 Crossref

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.

Citations

Citations to this article as recorded by

Lottery or Triage? Controlled Experimental Evidence from the COVID-19 Pandemic on Public Preferences for Allocation of Scarce Medical Resources
Rhys Llewellyn Thomas, Laurence SJ Roope, Raymond Duch, Thomas Robinson, Alexei Zakharov, Philip Clarke
Medical Decision Making.2026; 46(1): 102. CrossRef
Fairness preferences over allocation of scarce medical resources
Zijing Yang, Tigran Melkonyan, Zvi Safra
Social Science & Medicine.2025; 384: 118462. CrossRef
Validity, Reliability, and Framing Effects in Equity-Efficiency Trade-Off Studies: A Systematic Review
Victoria Chechulina, Andrew Chu, Quang Hung Lam, Camryn Kabir-Bahk, Shehzad Ali
Value in Health.2025;[Epub] CrossRef
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
JAMA Network Open.2024; 7(3): e241958. CrossRef
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
Promotion of Knowledge and Trust Surrounding Scarce Resource Allocation Policies
Russell G. Buhr, Ruby Romero, Lauren E. Wisk
JAMA Health Forum.2024; 5(10): e243509. 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

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