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Original Articles
Assessing Hospital Surgical Functions in Korea: A Functional Analysis Using the Disease Control Priorities, 3rd Edition Essential Surgery List (2013-2022)
Haibin Bai, Jin-Hwan Kim, Yukyung Park
J Prev Med Public Health. 2025;58(6):635-646.   Published online September 23, 2025
DOI: https://doi.org/10.3961/jpmph.25.407
  • 1,846 View
  • 223 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Korea has achieved near-universal health coverage through a predominantly privatized healthcare system. However, this structural fragmentation has created significant ambiguity regarding the roles of different healthcare organizations, particularly in ensuring equitable provision of essential surgical services across geographic and institutional boundaries.
Methods
We conducted a retrospective study using the full national health insurance claims database provided by the Health Insurance Review & Assessment Service (2013-2022). Essential surgical procedures from the Disease Control Priorities, 3rd edition Essential Surgery List were mapped to insurance claims codes, and their provision was analyzed across healthcare facilities and regions. Functional capacity was defined using minimum annual volume thresholds of 12, 24, 60, and 120 procedures.
Results
Essential surgery more than doubled between 2013 and 2022, increasing from 2.79 million to nearly 6 million cases. Superior general hospitals and general hospitals consistently delivered high volumes of essential surgeries, while hospital-level facilities experienced marked functional decline, particularly in obstetric services. We observed increasing centralization of surgical services in higher-tier and metropolitan facilities, alongside selective decentralization for lower-risk procedures such as cataract surgery. Regional disparities were especially pronounced for obstetric care.
Conclusions
Functional capacity for essential surgery remains highly uneven across hospitals and regions, undermining equitable access. Policy efforts should focus on strengthening lower-tier hospitals in underserved areas and implementing minimum functionality standards tailored to local needs. Clarifying institutional roles within Korea’s mixed healthcare system is essential to improving accountability and ensuring equitable distribution of essential surgical services.
Summary
Korean summary
본 연구는 DCP3 Essential Surgery List를 한국의 건강보험 청구자료(2013–2022)에 적용하여 필수수술 제공기관의 기능적 변화를 평가하였다. 전체 필수수술 건수는 크게 증가했음에도 불구하고 이를 제공하는 의료기관 수는 지속적으로 감소하며 지역 간 격차도 확대되고 있었다. 필수수술 접근성을 강화하기 위해서는 우선 의료기관 수준별로 제공해야 할 필수 기능을 명확히 규정하는 정책적 가이드가 필요하며, 이를 기반으로 지역 단위의 종합병원·병원급 기능을 지속적으로 모니터링하고 관리하는 체계를 마련해야 한다.
Key Message
This study applies the DCP3 Essential Surgery List to South Korea’s national health insurance claims data (2013–2022) and shows that, despite a substantial rise in essential surgery volumes, the number of institutions providing these procedures has declined, widening regional disparities. Strengthening access to essential surgery requires first establishing clear guidance on the functions expected at each level of care, followed by systematic monitoring to ensure that general and hospital-level facilities maintain the capacity to deliver these core services. Such a combined approach is critical for securing equitable and regionally sustained surgical access.
Association Between Objective Social Isolation and Unmet Medical Needs: A Nationwide Cross-sectional Study in Korea
Jeong Min Yang, Seul Ki Lee, Jae Hyun Kim
J Prev Med Public Health. 2024;57(3):242-251.   Published online April 27, 2024
DOI: https://doi.org/10.3961/jpmph.23.516
  • 15,781 View
  • 385 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
The aim of this study was to analyze the relationship between objective social isolation (SI) and unmet medical needs (UMN) in adults aged 19 and older.
Methods
A cross-sectional analysis was conducted of 208 619 adults aged 19 and older, excluding missing data, using the 2019 Korea Community Health Survey. To analyze the association between objective SI and UMN, the chi-square test and logistic regression analysis were performed.
Results
The prevalence of UMN was 1.14 times higher (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.06 to 1.23) among those with SI than among those without SI, and the OR for groups with 5 SI types was 2.77 (95% CI, 1.86 to 4.12) compared to those with no SI types. In addition, a stratified analysis by age group showed that the association between SI and UMN existed even in groups under 64 years old. However, among those aged 65 and older, SI was associated with an OR of 1.53 (95% CI, 1.37 to 1.71) for UMN compared to non-SI. As the number of SI types increased, the prevalence of UMN also increased, indicating a strong association between SI and UMN in older adults.
Conclusions
This study found that individuals with SI experienced UMN due to fear and anxiety about interpersonal relationships. Therefore, based on the results of this cross-sectional study, it is necessary to investigate the causal relationship between SI and UMN through future longitudinal data.
Summary
Korean summary
본 연구는 2019년 지역사회건강조사를 활용하여 사회적 고립과 미충족의료 간의 연관성을 분석한 연구이다. 분석 결과 사회적 고립이 있을 경우 비사회적고립 집단에 비하여 미충족의료 경험률이 높았고, 사회적 고립의 강도가 높아질수록 강한 연관성을 발견할 수 있었다. 본 연구 결과를 바탕으로 미충족의료 취약 집단에 대한 정책적, 제도적 기반 마련이 요구된다.
Key Message
This study analyzed the association between social isolation and unmet medical needs using the 2019 Korea Community Health Survey. The analysis revealed that individuals experiencing social isolation had a higher rate of unmet medical needs compared to the non-social isolation group. Furthermore, a stronger association was observed as the intensity of social isolation increased. Based on the results of this study, there is a need to establish policy and institutional foundations to support vulnerable groups with unmet medical needs.

Citations

Citations to this article as recorded by  
  • Factors associated with unmet healthcare needs among community-dwelling older adults in South Korea: a cross-sectional study using KNHANES 2023
    Heeyoung Hwang, Kyeongmin Jang
    BMC Geriatrics.2026;[Epub]     CrossRef
  • Unmet need for healthcare services among unemployed people – findings from a national survey in Finland
    Hanna Rinne, Ari-Pekka Sihvonen, Visa Väisänen, Lars Leemann, Anna-Mari Aalto
    BMC Health Services Research.2025;[Epub]     CrossRef
Identification of Unmet Healthcare Needs: A National Survey in Thailand
Sukanya Chongthawonsatid
J Prev Med Public Health. 2021;54(2):129-136.   Published online March 4, 2021
DOI: https://doi.org/10.3961/jpmph.20.318
  • 8,434 View
  • 180 Download
  • 9 Web of Science
  • 9 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
This study examined demographic factors hampering access to healthcare at hospitals and suggests policy approaches to improve healthcare management in Thailand.
Methods
The data for the study were drawn from a health and welfare survey conducted by the National Statistical Office of Thailand in 2017. The population-based health and welfare survey was systematically carried out by skilled interviewers, who polled 21 519 384 individuals. The independent variables related to demographic data (age, sex, religion, marital status, education, occupation, and area of residence), chronic diseases, and health insurance coverage. The dependent variable was the degree of access to healthcare. Multiple logistic regression analysis was subsequently performed on the variables found to be significant in the univariate analysis.
Results
Only 2.5% of the population did not visit a hospital when necessary for outpatient-department treatment, hospitalization, or the provision of oral care. The primary reasons people gave for not availing themselves of the services offered by government hospitals when they were ill were—in descending order of frequency—insufficient time to seek care, long hospital queues, travel inconvenience, a lack of hospital beds, unavailability of a dentist, not having someone to accompany them, and being unable to pay for the transportation costs. Multiple logistic regression analysis showed that failure to access the health services provided at hospitals was associated with demographic, educational, occupational, health welfare, and geographic factors.
Conclusions
Accessibility depends not only on health and welfare benefit coverage, but also on socioeconomic factors and the degree of convenience associated with visiting a hospital.
Summary

Citations

Citations to this article as recorded by  
  • Nationwide trends in pediatric obesity in Thailand, 2015–2023: prevalence, morbidity, mortality, and COVID-19–related disparities
    Tran Cong Ly, Suchaorn Saengnipanthkul, Phanthila Sitthikarnkha, Leelawadee Techasatian, Rattapon Uppala, Pope Kosalaraksa
    BMC Public Health.2026;[Epub]     CrossRef
  • Impact of Oral Health Chatbot With and Without Toothbrushing Training on Childhood Caries
    Jaranya Hunsrisakhun, Supawadee Naorungroj, Watcharawalee Tangkuptanon, Pissamai Wattanasit, Kittiwara Pupong, Samerchit Pithpornchaiyakul
    International Dental Journal.2025; 75(2): 1348.     CrossRef
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    Md. Mizanur Rahman, Md. Safayet Hossain, Ryota Nakamura, Md. Ashraful Alam, Syed Khurram Azmat, Motohiro Sato
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    Swetalina Nayak, Soumya Ranjan Nayak, Alice Alice, Debadutta Sahoo, Srikanta Kanungo, Tanveer Rehman, Sanghamitra Pati, Subrat Kumar Palo
    Frontiers in Nephrology.2023;[Epub]     CrossRef
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    Hyo Lyun Roh, Sang Dol Kim
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    Katika Akksilp, Falk Müller-Riemenschneider, Yot Teerawattananon, Cynthia Chen
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    Soroush Moallef, Travis Salway, Nittaya Phanuphak, Katri Kivioja, Suparnee Pongruengphant, Kanna Hayashi
    International Journal of Mental Health and Addiction.2022; 20(6): 3244.     CrossRef
  • The impact of the Syrian Refugee Crisis on the health access in Turkiye: A synthetic control analysis
    Hüseyin İKİZLER, Aslı DOLU, Emre YÜKSEL
    Uluslararası Ekonomi ve Yenilik Dergisi.2022; 8(2): 165.     CrossRef
Association Between Convenience of Transportation and Unmet Healthcare Needs of Rural Elderly in Korea
Youngeun Choi, Kiryong Nam, Chang-yup Kim
J Prev Med Public Health. 2019;52(6):355-365.   Published online October 3, 2019
DOI: https://doi.org/10.3961/jpmph.19.172
  • 14,635 View
  • 257 Download
  • 30 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
In rural areas of Korea, where public transportation infrastructure is lacking and alternative systems are poor, the elderly experience inconveniences in using healthcare, although their need is high. This study aimed to analyze the association between the convenience of transportation and unmet healthcare needs among the rural elderly.
Methods
The data used were collected in the 2016 Community Health Survey among rural elderly individuals aged 65 or older. Dependent variable was the unmet healthcare needs, explanatory variable was the convenience of transportation. The elderly were divided into 3 groups: with no driver in the household, with a driver, and the elderly individual was the driver (the self-driving group). Covariates were classified into predisposing, enabling, and need factors. They included gender, age, education, income, economic activity, household type, motor ability, subjective health level, number of chronic diseases, anxiety/depression, and pain/discomfort. The data were analyzed using logistic regression and stratification.
Results
A significant association was found between the convenience of transportation and unmet healthcare needs. When examined unadjusted odds ratio of the group with a driver in the household, using the group with no driver as a reference, was 0.61 (95% confidence interval [CI], 0.54 to 0.68), while that of the self-driving group was 0.34 (95% CI, 0.30 to 0.38). The odds ratios adjusted for all factors were 0.69 (95% CI, 0.59 to 0.80) and 0.79 (95% CI, 0.67 to 0.91).
Conclusions
We confirmed a significant association between inconvenient transportation and unmet healthcare needs among the rural elderly even after adjustment for existing known factors. This implies that policies aimed at improving healthcare accessibility must consider the means of transportation available.
Summary
Korean summary
대중교통 인프라가 부족하고 대안적 교통수단 체계가 미흡한 농촌 지역 노인들은 의료 필요는 높으나 도보이동이나 불편한 이동수단을 이용하기 어려워 의료이용에 불편을 겪는다. 본 연구는 의료접근성 향상과 불평등한 접근성 문제에 대한 제안의 근거 마련을 목적으로 질병관리본부 지역사회건강조사 데이터를 이용하여 농촌 노인의 이동수단의 편의성과 미충족의료 경험의 연관성을 살펴보았다. 분석결과 농촌지역 노인에게 교통편 불편은 미충족의료 경험의 주된 이유로 나타났고 기존에 알려진 요인들을 보정한 후에도 이동수단의 편의성과 미충족의료 경험 사이에 유의한 관계가 있음을 확인하였다.

Citations

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    Xizi Wan, Yiyu Ao, Zhongmou Huang, Miao Yu
    Health Policy and Technology.2026; 15(1): 101123.     CrossRef
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    Jialong Tan, Jian Wang, Lingxuan Xu, Peilong Li, Jingjie Sun, Chen Chen
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    Yeong Jun Ju, Woorim Kim, Kyujin Chang, Tae Hoon Lee, Soon Young Lee
    Preventive Medicine.2024; 178: 107793.     CrossRef
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    Vanessa Stjernborg, Gustav Lopez Svensson
    Transportation Research Part D: Transport and Environment.2024; 126: 104030.     CrossRef
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    Korean Journal of Community Nutrition.2024; 29(4): 348.     CrossRef
  • Health Expenditures and Unmet Health Care Needs of Single-Person Households between Pre-Baby Boomer and Baby Boomer Generations: A Secondary Data Analysis
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    Korean Journal of Adult Nursing.2023; 35(1): 13.     CrossRef
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    Transportation Research Interdisciplinary Perspectives.2023; 21: 100882.     CrossRef
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    Lei Huang, Hongyan Wu, Fengjian Zhang, Huimin Zhao, Yuqin Chen, Mingjiao Feng, Yanjie You, Xiao Peng, Chunyan Guan, Yilan Liu
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  • Identification of Unmet Healthcare Needs: A National Survey in Thailand
    Sukanya Chongthawonsatid
    Journal of Preventive Medicine and Public Health.2021; 54(2): 129.     CrossRef
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The Association Among Individual and Contextual Factors and Unmet Healthcare Needs in South Korea: A Multilevel Study Using National Data
Seung Eun Lee, Miyeon Yeon, Chul-Woung Kim, Tae-Ho Yoon
J Prev Med Public Health. 2016;49(5):308-322.   Published online September 7, 2016
DOI: https://doi.org/10.3961/jpmph.16.035
  • 12,488 View
  • 233 Download
  • 20 Crossref
AbstractAbstract PDF
Objectives
The objective of this study is to investigate associations between contextual characteristics and unmet healthcare needs in South Korea after accounting for individual factors.
Methods
The present study used data from the 2012 Korean Community Health Survey (KCHS) of 228 902 adults residing within 253 municipal districts in South Korea. A multilevel analysis was conducted to investigate how contextual characteristics, defined by variables that describe the regional deprivation, degree of urbanity, and healthcare supply, are associated with unmet needs after controlling for individual-level variables.
Results
Of the surveyed Korean adults, 12.1% reported experiencing unmet healthcare needs in the past. This figure varied with the 253 districts surveyed, ranging from 2.6% to 26.2%. A multilevel analysis found that the association between contextual characteristics and unmet needs varied according to the factors that caused the unmet needs. The degree of urbanity was associated with unmet need due to “financial burden” (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.42 to 0.66 for rural vs. metropolitan), but not unmet need due to “service not available when needed.” There were no significant associations between these unmet need measures and regional deprivation. Among individual-level variables, income level showed the highest association with unmet need due to “financial burden” (OR, 5.63; 95% CI, 4.76 to 6.66), while employment status showed a strong association with unmet need due to “service not available when needed.”
Conclusions
Our finding suggests that different policy interventions should be considered for each at-risk population group to address the root cause of unmet healthcare needs.
Summary

Citations

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    Hyunjee Kim, Jaeyu Park, Jinyoung Jeong, Saiah Kim, Hayeon Lee, Hyeon Jin Kim, Yejun Son, Soeun Kim, Sooji Lee, Kyeongmin Lee, Hyesu Jo, Yesol Yim, Masoud Rahmati, Damiano Pizzol, Lee Smith, Ho Geol Woo, Dong Keon Yon
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English Abstract
Subjective Satisfaction with Medical Care among Older People: Comprehensiveness, General Satisfaction and Accessibility.
Hwa Joon Kim, Young Koh, Eun Jeong Chun, Soong Nang Jang, Chang Yup Kim
J Prev Med Public Health. 2009;42(1):35-41.
DOI: https://doi.org/10.3961/jpmph.2009.42.1.35
  • 6,221 View
  • 51 Download
  • 4 Crossref
AbstractAbstract PDF
OBJECTIVES
The changing population age structure and rapidly increasing medical costs make providing high-quality, effective medical care for the elderly a challenge. This study assessed the satisfaction with medical care in terms of comprehensiveness, general satisfaction, and accessibility among community-dwelling Korean elders. METHODS: Data were obtained from a nationwide representative sample of the older adults(aged 65 years old or older) living in the community, who participated in a 2006 telephone survey conducted using random digit dialing (n=881). General satisfaction, comprehensiveness and accessibility were measured using a 10-item satisfaction survey questionnaire. Descriptive analysis was used to assess the distribution of each of three components of subjective satisfaction. Analysis of covariance (ANCOVA) was used to examine the association of each of the three components with socioeconomic variables. RESULTS: Comprehensiveness and general satisfaction were low among older people with a high socioeconomic status. Accessibility was evaluated as low among older people of low socioeconomic status, those living in rural areas and those who were medical aid beneficiaries. CONCLUSIONS: Urgent interventions should be considered in order to improve accessibility to medical care for elders of low socioeconomic status and those living in rural communities. Given the rapid aging of the population, we need to develop a monitoring system to improve the quality of geriatric care.
Summary

Citations

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Original Articles
Determining the Location of Urban Health Sub-center According to Geographic Accessibility.
Kun Sei Lee, Chang Yup Kim, Yong Ik Kim, Youngsoo Shim
Korean J Prev Med. 1996;29(2):215-226.
  • 2,412 View
  • 23 Download
AbstractAbstract PDF
Decentralization to local governments and amending of Health center Law are to promote the efforts of health planning at the level of local agencies. In the health facility planning, it is important to take into account that what to be built, where to be located, how far should be service area and so forth, because health facilities are immovable, and require capital as well as personnel and consumable supplies. The aim of our study, answering to the question of 'where to be located?`, is to determine the best location of urban health sub-center. At the local level, planning is the matter of finding the best location of specific facility, in relation to population needs. We confine the accessibility, which is basic to location planning, to geographic one. Location-Allocation Model is used to solve the problem where the location is to maximize geographic accessibility. To minimize the weighted travel distance, objective function, Rk= aijwidij is used. Distances are measured indirectly by map measure-meter with l:25,000 Suwon map, and each potential sites, 10 administrative Dongs in Kwonson Gu, Suwon, are weighted by each number of households, total population, maternal age group, child age group, old age group, Relief for the livelihood, and population/primary health clinics. we find that Kuwoon-Dong, Seodun-Dong, Seryu3-Dong, according the descending orders, are best sites which can minimize the weighted distance, and conclude that it is reasonable to determine the location of urban health sub-center among those sites.
Summary
Determinants Influencing the Utilization of the Rural Health Sub-centers.
Jong Doo Kang
Korean J Prev Med. 1990;23(3):316-323.
  • 2,613 View
  • 21 Download
AbstractAbstract PDF
To analyze of determinants infuencing the utilization of the rural health sub-centers (HSCs), 116 of 144 HSCs in Kyoung Gi Do, were selected for this study. The self-administered questionnaire covering the environment and the characteristics of doctors working in the HSCs was sent to HSCs by mail. 105 questionnaires were returned of which 88 were completed and use in the study. The dependant variable was the total number of medical care visits to the HSCs from January 1, 1990 to March 31, 1990. Data was analyzed by multiple regression analysis. The results were as follows: First, the more time required to set from the HSCs to nearest hospital or clinic, the higher the utilization of the HSCs. Second, the more geographically accessible the HSCs was, the more utilization the HSCs. Third, the older of the HSCs doctors were, the more utilization of the HSCs. Fourth, the higher frequency of bus service from the HSCs to town, the more utilization of the HSCs. Fifth, the more time required from the HSCs to town, the more utilization of the HSCs. Therefore, the determinants influencing the utilization of the rural HSCs in Kyong-Gi Do, are mostly geographical accessibility of medical care.
Summary
Comparative Studys
Differences in Medical Care Utilization Rates of the Disabled and the Non-disabled with Ambulatory Care Sensitive Conditions.
Sang Jun Eun, Jee Young Hong, Jin Yong Lee, Jin Seok Lee, Yoon Kim, Yong Ik Kim, Youngsoo Shin
J Prev Med Public Health. 2006;39(5):411-418.
  • 3,131 View
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AbstractAbstract PDF
OBJECTIVES
The purpose of this study was to determine whether the disabled have worse access to primary care than the non-disabled. METHODS: We used the National Disability Registry data and the National Health Insurance data for the calendar year 2003, and we analyzed 807,380 disabled persons who had been registered until December 2001 and we also analyzed 1,614,760 non-disabled persons for nine ambulatory care sensitive conditions (ACSCs). The rates of physician visits and hospitalizations for the patients with ACSCs were compared between the disabled and the nondisabled. Multiple logistic regression analysis was used to evaluate the association between medical care utilization and disability and to assess the association between hospitalization and the number of physician visits while controlling for potential confounders. RESULTS: The numbers of physician visits per 100 patients were 0.78~0.97 times lower for the disabled than that for the non-disabled with five of nine ACSCs. The numbers of hospitalizations per 100 patients were 1.16~1.77 times higher for the disabled than that for the non-disabled with all the ACSCs. While the ORs of a physician visit for the disabled were significantly lower than that for the non-disabled with all the ACSCs (OR: 0.44~0.70), and the ORs of hospitalization for the disabled were significantly higher (OR: 1.16~1.89). The lower physician visit group (number of physician visits < or =1) was more likely to be hospitalized than the higher physician visit group (number of physician visits > or =2) (OR: 1.69~19.77). The effect of the physician visit rate on hospitalization was larger than the effect of disability on hospitalization. CONCLUSIONS: The results suggest that the disabled were more likely to be hospitalized for ACSCs due to their lower access to primary care.
Summary
The Relation between Type of Insurance and Acute Appendicitis Rupture Rate.
Baeg Ju Na, Jee Young Hong, Keon Yeop Kim, Moo Sik Lee, Hae Sung Nam, Jeong Soo Im, Jung Ae Rhee
J Prev Med Public Health. 2004;37(3):267-273.
  • 3,099 View
  • 37 Download
AbstractAbstract PDF
OBJECTIVES
This study was aimed at investigating the medical service utilization pattern of patients who use public medical aid compared to those who have health insurance. METHODS: We selected every patient between the age of 18 and 69 who used public medical aid from January 1, 1999, to December 31, 2001, in Gwangju metropolitan city, South Korea. For comparison, a list of patients with health insurance was gathered for same period. Then the medical records of those who had been hospitalized for acute appendicitis were selected among both groups. Of those records, we compared the number of cases of ruptured appendicitis to cases of whole acute appendicitis in both groups. Regarding coding for ruptured appendicitis, International Classification of Diseases - 10 (ICD-10) was used. Multiple logistic regression was used as a statistical tool to determine the effectiveness of risk factors. RESULTS: Even after adjusting for risk factors, such as age and sex, the proportion of perforation of acute appendicitis among public medical aid patients was found to be significantly higher than among insured patients. CONCLUSIONS: This comparative study on ruptured appendicitis among public medical aid patients and insured patients, indicates that the proportion of perforation of acute appendicitis could be an index showing that these types of patients utilize medical services differently than insured patients. We know that when abdominal pain is not properly treated at the outset, it easily develops into ruptured appendicitis complicated with peritonitis. Considering this data analysis, we guess the public medical aid system to have significant problem with medical accessibility. So additional and systematic research on the pattern of utilization of medical services of public medical aid patients is needed.
Summary
JPMPH : Journal of Preventive Medicine and Public Health
© Korean Society for Preventive Medicine.
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