Journal of Preventive Medicine and Public Health

Original Articles

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

3,475 View
117 Download
1 Crossref

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

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

Breaking the Gender Gap: A Two-part Observational Study of the Gender Disparity Among Korean Academic Emergency Physicians: Mi Jin Lee, ChangHo Kim; J Prev Med Public Health. 2020;53(5):362-370. Published online August 7, 2020; DOI: https://doi.org/10.3961/jpmph.20.286

3,669 View
85 Download
1 Crossref

Abstract PDF Supplementary Material

Objectives
Despite greater access to training positions and the presence of more women in emergency medicine, it has remained a men-dominated field. This study aims to identify the key issues causing the gender gap in Korea and establish measures to overcome them.
Methods
Using the annual statistical reports of the National Emergency Medical Center and data published on the Korean Society of Emergency Medicine website, cases that listed the current status and positions of members in its organization and its committees were analyzed. Secondary analysis was conducted using data from the 2015 Korean Society of Emergency Survey that included physicians’ demographics, academic ranking, years of experience, clinical work hours, training and board certification, core faculty status, position, and salaries.
Results
As of September 2019, women account for only 12.7% of the total number of emergency physicians (EP) in Korea; of 119 chair/ vice‐chair academic positions, women represented only 9.2%. Women EP were more often assistant professors and fellowship-trained, with fewer in core faculty. However, they worked the same numbers of clinical hours as their men counterparts. The median annual salary of women EP was less than that of men EP after adjusting for academic hospital rank, clinical hours, and core faculty status.
Conclusions
A gender gap still exists among Korean EP, and women earn less than men regardless of their rank, clinical hours, or training. Future studies should evaluate more data and develop system-wide practices to eliminate gender disparities.

Summary

Citations

Citations to this article as recorded by

Gender distribution in emergency medicine journals: editorial board memberships in top-ranked academic journals
Svenja Ravioli, Adrienne Rupp, Aristomenis K. Exadaktylos, Gregor Lindner
European Journal of Emergency Medicine.2021; 28(5): 380. CrossRef

Review

A Systematic Review of the Economic Evaluation of Telemedicine in Japan: Miki Akiyama, Byung-Kwang Yoo; J Prev Med Public Health. 2016;49(4):183-196. Published online June 22, 2016; DOI: https://doi.org/10.3961/jpmph.16.043

16,838 View
402 Download
35 Crossref

Abstract PDF

Objectives
There is no systematic review on economic evaluations of telemedicine in Japan, despite over 1000 trials implemented. Our systematic review aims to examine whether Japan’s telemedicine is cost-saving or cost-effective, examine the methodological rigorousness of the economic evaluations, and discuss future studies needed to improve telemedicine’s financial sustainability.
Methods
We searched five databases, including two Japanese databases, to find peer-reviewed articles published between January 1, 2000 and December 31, 2014 in English and Japanese that performed economic evaluations of Japan’s telemedicine programs. The methodological rigorousness of the economic analyses was assessed with a well-established checklist. We calculated the benefit-to-cost ratio (BCR) when a reviewed study reported related data but did not report the BCR. All cost values were adjusted to 2014 US dollars.
Results
Among the 17 articles identified, six studies reported on settings connecting physicians for specialist consultations, and eleven studies on settings connecting healthcare providers and patients at home. There are three cost-benefit analyses and three cost-minimization analyses. The remaining studies measured the benefit of telemedicine only, using medical expenditure saved or users’ willingness-to-pay. There was substantial diversity in the methodological rigorousness. Studies on teledermatology and teleradiology indicated a favorable level of economic efficiency. Studies on telehomecare gave mixed results. One cost-benefit analysis on telehomecare indicated a low economic efficiency, partly due to public subsidy rules, e.g., a too short budget period.
Conclusions
Overall, telemedicine programs in Japan were indicated to have a favorable level of economic efficiency. However, the scarcity of the economic literature indicates the need for further rigorous economic evaluation studies.

Summary

Citations

Citations to this article as recorded by

Key Factors Influencing the Operationalization and Effectiveness of Telemedicine Services in Henan Province, China: Cross-Sectional Analysis
Xianying He, Fangfang Cui, Minzhao Lyu, Dongxu Sun, Xu Zhang, Jinming Shi, Yinglan Zhang, Shuai Jiang, Jie Zhao
Journal of Medical Internet Research.2024; 26: e45020. CrossRef
Analysis of the Forces Driving Public Hospitals’ Operating Costs Using LMDI Decomposition: The Case of Japan
Kiyotoshi Kou, Yi Dou, Ichiro Arai
Sustainability.2024; 16(2): 853. CrossRef
Remote consultations in community mental health: A qualitative study of clinical teams
Robyn McCarron, Anna Moore, Ilana Foreman, Emily Brewis, Olivia Clarke, Abby Howes, Katherine Parkin, Diana Luk, Maisie Satchwell Hirst, Emilie Sach, Aimee Shipp, Lorna Stahly, Anupam Bhardwaj
Journal of Psychiatric and Mental Health Nursing.2024; 31(5): 857. CrossRef
Relationship Between Clinics Offering Telemedicine and Population Density in Japan: An Ecological Study
Takashi Kuwayama, Kazuhiko Kotani
Telemedicine Reports.2024; 5(1): 99. CrossRef
A Study of Factors Influencing the Acceptance of non-Face-to-Face Treatment Based on Social Cognitive Theory
Myung Soon Kwon, Ji Hye Jang, Hyun Sik Kim, Yeon Jeong Heo
Quality Improvement in Health Care.2024; 30(1): 55. CrossRef
Case study of a healthcare virtual community model
Kun-Huang Huarng, Cheng-Fang Lee, Tiffany Hui-Kuang Yu
Technological Forecasting and Social Change.2023; 188: 122281. CrossRef
COVID-19 pandemic and hypertension: an updated report from the Japanese Society of Hypertension project team on COVID-19
Shigeru Shibata, Kazuo Kobayashi, Masami Tanaka, Kei Asayama, Eiichiro Yamamoto, Hironori Nakagami, Satoshi Hoshide, Takuya Kishi, Chisa Matsumoto, Masaki Mogi, Satoshi Morimoto, Koichi Yamamoto, Masashi Mukoyama, Kazuomi Kario, Koichi Node, Hiromi Rakugi
Hypertension Research.2023; 46(3): 589. CrossRef
The Twenty Factors that Made Teledermatology Consultation a Matured Application: A Systematic Review
Garehatty Rudrappa Kanthraj
Clinical Dermatology Review.2023; 7(1): 10. CrossRef
Applications, opportunities, and challenges in using Telehealth for burn injury management: A systematic review
Mohammad Hosein Hayavi-Haghighi, Jahanpour Alipour
Burns.2023; 49(6): 1237. CrossRef
Economic evaluation of remote patient monitoring and organizational analysis according to patient involvement: a scoping review
Myriam Le Goff-Pronost, Isabelle Bongiovanni-Delarozière
International Journal of Technology Assessment in Health Care.2023;[Epub] CrossRef
Acceptability and feasibility of assisted telepsychiatry in routine healthcare settings in India: a qualitative study
Abhijit Nadkarni, Ankur Garg, Ravindra Agrawal, Seema Sambari, Kedar Mirchandani, Richard Velleman, Devika Gupta, Urvita Bhatia, Godwin Fernandes, Ethel D’souza, Akshada Amonkar, Anil Rane
Oxford Open Digital Health.2023;[Epub] CrossRef
Beyond the Nuts and Bolts: Tele-Critical Care Patients, Workflows, and Activity Patterns
Christina Canfield, Silvia Perez-Protto, Matthew Siuba, Steven Hata, Chiedozie Udeh
Telemedicine and e-Health.2022; 28(1): 73. CrossRef
Effectiveness of Pediatric Teleconsultation to Prevent Skin Conditions in Infants and Reduce Parenting Stress in Mothers: Randomized Controlled Trial
Tomohisa Ando, Rintaro Mori, Kenji Takehara, Mari Asukata, Shuichi Ito, Akira Oka
JMIR Pediatrics and Parenting.2022; 5(1): e27615. CrossRef
The Willingness to Pay for Telemedicine Among Patients With Chronic Diseases: Systematic Review
Valerie Chua, Jin Hean Koh, Choon Huat Gerald Koh, Shilpa Tyagi
Journal of Medical Internet Research.2022; 24(4): e33372. CrossRef
Telemedicine and Community Health Projects in Asia
Anil Kumar Jha, Erika Sawka, Bhagirath Tiwari, Huiting Dong, Choon Chiat Oh, Seyedali Ghaemi, Xuejiao Zhang, Adarsh Kumar Jha
Dermatologic Clinics.2021; 39(1): 23. CrossRef
A new telestroke network system in northern area of Okayama prefecture
Ryo Sasaki, Toru Yamashita, Yoshio Omote, Mami Takemoto, Nozomi Hishikawa, Taijun Yunoki, Kazuki Kobayashi, Takashi Sawata, Yuki Sato, Junichi Kubota, Masayuki Mizobuchi, Takashi Hayashi, Koji Abe
Neurology and Clinical Neuroscience.2021; 9(2): 166. CrossRef
Opportunities and challenges for contactless healthcare services in the post-COVID-19 Era
Sang M. Lee, DonHee Lee
Technological Forecasting and Social Change.2021; 167: 120712. CrossRef
Creation of a Learning Environment Contributing to the Development of Communication Competencies within the System of Continuing Education of Medical Doctors
NS Zhuravskaya, MV Bektasova, BV Okun’, VA Yanovich
ЗДОРОВЬЕ НАСЕЛЕНИЯ И СРЕДА ОБИТАНИЯ - ЗНиСО / PUBLIC HEALTH AND LIFE ENVIRONMENT.2021; : 95. CrossRef
Economic Aspects of Delivering Primary Care Services: An Evidence Synthesis to Inform Policy and Research Priorities
LORCAN CLARKE, MICHAEL ANDERSON, ROB ANDERSON, MORTEN BONDE KLAUSEN, REBECCA FORMAN, JENNA KERNS, ADRIAN RABE, SØREN RUD KRISTENSEN, PAVLOS THEODORAKIS, JOSE VALDERAS, HANS KLUGE, ELIAS MOSSIALOS
The Milbank Quarterly.2021; 99(4): 974. CrossRef
Knowledge Update on the Economic Evaluation of Pacemaker Telemonitoring Systems
Antonio Lopez-Villegas, César Leal-Costa, Mercedes Perez-Heredia, Irene Villegas-Tripiana, Daniel Catalán-Matamoros
International Journal of Environmental Research and Public Health.2021; 18(22): 12120. CrossRef
Problems of development of telemedicine technologies in Russia through the prism of foreign experience
O. S. Kobyakova, F. N. Kadyrov
National Health Care (Russia).2021; 2(2): 13. CrossRef
Economic evaluation of E-health interventions compared with alternative treatments in older persons’ care
Aziz Rezapour, Seyede Sedighe Hosseinijebeli, Saeed Bagheri Faradonbeh
Journal of Education and Health Promotion.2021; 10(1): 134. CrossRef
A Multicenter Case-Historical Control Study on Short-Term Outcomes of Tele-Intensive Care Unit
Awad Al-Omari, Abbas Al Mutair, Maram Al Ammary, Fadi Aljamaan
Telemedicine and e-Health.2020; 26(5): 645. CrossRef
Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation
Nkiruka D. Eze, Céu Mateus, Tiago Cravo Oliveira Hashiguchi, Hannah E. Carter
PLOS ONE.2020; 15(8): e0237585. CrossRef
Understanding Medical Students’ Attitudes Toward Learning eHealth: Questionnaire Study
Kjeld Vossen, Jan-Joost Rethans, Sander M J van Kuijk, Cees P van der Vleuten, Pieter L Kubben
JMIR Medical Education.2020; 6(2): e17030. CrossRef
Тelemedicine technologies in occupational health and pathology
Sergey A. Saiganov, Vadim I. Mazurov, Viktor V. Shilov, Sergey A. Gorbanev
Hygiene and sanitation.2020; 99(9): 961. CrossRef
Barriers to use of remote monitoring technologies (RMT) used to support COVID-19 patients: A rapid review (Preprint)
Elizabeth Houlding, Kedar Mate, Kim Engler, David Ortiz-Paredes, Marie-Pascale Pomey, Joseph Cox, Tarek Hijal, Bertrand Lebouché
JMIR mHealth and uHealth.2020;[Epub] CrossRef
Feasibility of support vector machine learning in age‐related macular degeneration using small sample yielding sparse optical coherence tomography data
Gwenolé Quellec, Jens Kowal, Pascal W. Hasler, Hendrik P. N. Scholl, Sandrine Zweifel, Balaskas Konstantinos, João Emanuel Ramos de Carvalho, Tjebo Heeren, Catherine Egan, Adnan Tufail, Peter M. Maloca
Acta Ophthalmologica.2019;[Epub] CrossRef
Exploring the Impact of a Telehealth Care System on Organizational Capabilities and Organizational Performance from a Resource-Based Perspective
Chun-Hsun Chen, Yu-Li Lan, Wei-Pang Yang, Fang-Ming Hsu, Chin-Lon Lin, Hsing-Chu Chen
International Journal of Environmental Research and Public Health.2019; 16(20): 3988. CrossRef
Addressing cost and time barriers in chronic disease management through telemedicine: an exploratory research in select low- and middle-income countries
Saleem Sayani, Momina Muzammil, Karima Saleh, Abdul Muqeet, Fabiha Zaidi, Tehniat Shaikh
Therapeutic Advances in Chronic Disease.2019; 10: 204062231989158. CrossRef
Estado actual de la telemedicina: ¿dónde estamos y qué nos queda por hacer?
Francesc García Cuyàs, Núria Vàzquez, Marc de San Pedro, Margarita Hospedales
Medicina Clínica.2018; 150(4): 150. CrossRef
State of the art of the telemedicine. Where are we and what is pending to be done?
Francesc García Cuyàs, Núria Vàzquez, Marc de San Pedro, Margarita Hospedales
Medicina Clínica (English Edition).2018; 150(4): 150. CrossRef
Comparison between High- and Low-Cost Transmission of Tele-Anesthesia in Japan
Yoh Sugawara, Tetsuya Miyashita, Yusuke Mizuno, Yusuke Nagamine, Tomoyuki Miyazaki, Ayako Kobayashi, Kentaro Tojo, Yasuhiro Iketani, Shunsuke Takaki, Takahisa Goto
Journal of Healthcare Engineering.2018; 2018: 1. CrossRef
Comparative cost-benefit analysis of tele-homecare for community-dwelling elderly in Japan: Non-Government versus Government Supported Funding Models
Miki Akiyama, Chon Abraham
International Journal of Medical Informatics.2017; 104: 1. CrossRef
The use of telemedicine for delivering healthcare in Japan: Systematic review of literature published in Japanese and English languages
Jun Ito, Sisira Edirippulige, Takeshi Aono, Nigel R Armfield
Journal of Telemedicine and Telecare.2017; 23(10): 828. CrossRef

Original Articles

Psychological, Social, and Environmental Factors Associated With Utilization of Senior Centers Among Older Adults in Korea: Hyun-Shik Kim, Masashi Miyashita, Kazuhiro Harada, Jong-Hwan Park, Jae-Moo So, Yoshio Nakamura; J Prev Med Public Health. 2012;45(4):244-250. Published online July 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.4.244

8,423 View
86 Download
3 Crossref

Abstract PDF

Objectives

The purpose of the study was to examine the relationships among the psychological, social, and environmental factors influencing the utilization of senior centers among older adults in Korea.

Methods

A questionnaire survey was administered to two types of older adults who lived in Seoul, Korea: 262 older adults who used senior centers (3 places) and 156 older adults who did not use senior centers.

Results

Our results showed clearly that the utilization of the senior centers in Korea is affected by higher self-efficacy (odds ratio [OR], 6.08; 95% confidence interval [CI], 3.31 to 12.32), higher perceived benefits (OR, 1.71; 95% CI, 1.16 to 4.36), lower perceived barriers (OR, 6.43; 95% CI, 3.07 to 11.45), higher family support (OR, 4.21; 95% CI, 2.02 to 8.77), and higher support from friends (OR, 4.08; 95% CI, 2.38 to 7.81). The results also showed that participants whose total travel time was 15 to 29 minutes (OR, 2.84; 95% CI, 1.21 to 3.64) or less than 14 minutes (OR, 4.68; 95% CI, 3.41 to 8.41) were more likely to use a senior center than those who had to travel more than 30 minutes.

Conclusions

This study showed that the utilization of senior centers in Korea is affected by psychological, social, and environmental factors, specifically by self-efficacy, perceived benefits, perceived barriers, social support, convenience of transportation, and total travel time to the senior centers. The effects of longer-term utilization of the senior centers by non-users on health-related outcomes in a large population warrant attention.

Summary

Citations

Citations to this article as recorded by

Kaleidoscopic associations between life outside home and the technological environment that shape occupational injustice as revealed through cross-sectional statistical modelling
Sarah Wallcook, Louise Nygård, Anders Kottorp, Sophie Gaber, Georgina Charlesworth, Camilla Malinowsky
Journal of Occupational Science.2021; 28(1): 42. CrossRef
How Does the Built Environment in Compact Metropolitan Cities Affect Health? A Systematic Review of Korean Studies
Dong Ha Kim, Seunghyun Yoo
International Journal of Environmental Research and Public Health.2019; 16(16): 2921. CrossRef
Older Adults’ Social Relationships and Health Care Utilization: A Systematic Review
Nicole K. Valtorta, Danielle Collingridge Moore, Lynn Barron, Daniel Stow, Barbara Hanratty
American Journal of Public Health.2018; 108(4): e1. CrossRef

Risk-Based Damage Cost Estimation on Mortality Due to Environmental Problems.: Ye Shin Kim, Yong Jin Lee, Hoa Sung Park, Dong Chun Shin; Korean J Prev Med. 2003;36(3):230-238.

2,235 View
35 Download

Abstract PDF: OBJECTIVES
To estimate the value of statistical life (VSL) and health damage cost on theoretical mortality estimates due to environmental pollution. METHODS: We assessed the health risk on three environmental problems and eight sub-problems. Willingness to pay (WTP) was elucidated from a questionnaire survey with dichotomous contingent valuation method and VSL (which is the division of WTP by the change of risk reduction) calculated from WTP. Damage costs were estimated by multiplying VSL by the theoretical mortality estimates. RESULTS: VSLs from death caused by air pollution, indoor air pollution and drinking water contamination were about 0.3, 0.5 and 0.3 billion won, respectively. Damage costs of particulate matters (PM10) and radon were higher in the sub-problems and were above 100 billion won. Because damage cost depends on theoretical mortality estimate and WTP, its uncertainty is reduced in the estimating process. CONCLUSION: Health damage cost or risk benefit should be considered as one scientific criterion for decision making in environmental policy.; Summary

Risk Factors for Cerebrovascular Disorders in Koreans.: Jong Ku Park, Ki Soon Kim, Chun Bae Kim, Tae Yong Lee, Duk Hee Lee, Kwang Wook Koh, Kang Sook Lee, Sun Ha Jee, Il Suh, So Yeon Ryu, Kee Ho Park; Korean J Prev Med. 2001;34(2):157-165.

2,266 View
24 Download

Abstract PDF: OBJECTIVES
To identify the risk factors of cerebrovascular disorders(CVD) in Koreans using a nested case-control study. METHODS: The cohort consisted of beneficiaries who had taken health examinations of the Korea Medical Insurance Corporation (KMIC cohort: 115,600 persons) in 1990 and 1992 consecutively. Four hundred and twenty five (425) cases were selected following the validation of diagnosis among 2,026 reported CVD (I60-I68) inpatients during the year from 1993 to 1997. Controls were matched (1:1) with age and gender of the cases among inpatients without CVD during the same period. The source of data in this study were the files of the 1990 health examinations and the 1992 health questionnaires, as well as an additional telephone survey undertaken from March to November 1999. RESULTS: In a bivariate analysis and multiple logistic regression analysis, risk factors for total CVD were hyperglycemia and hypertension. Unrespectively, the odds ratio of ex-smoker was significantly lower than that of those who had never smoked. The risk factors for ischemic CVD also were hyperglycemia and hypertension. However, only blood pressure was found to be a risk factor for hemorrhagic CVD. Hypercholesterolemia was not a risk factor for total CVD, ischemic CVD, and hemorrhagic CVD. CONCLUSION: We concluded that the most important risk factor for CVD (including subtype) in Koreans was hypertension.; Summary

Cost-benefit Analysis of Mandatory Prescription in Korea.: Young Keon Jee, Han Joong Kim, Eun Cheol Park, Hye Young Kang; Korean J Prev Med. 2000;33(4):484-494.

2,282 View
33 Download

Abstract PDF: OBJECTIVE
To evaluate the relative benefits and the costs associated with the introduction of the new pharmaceutical provision called 'Mandatory Prescription Syste m' which separates the role of physicians from that of pharmacists with respect to the prescription and dispensation of from the perspective of consumers (i.e., patients). METHODS: The costs of the system were measured by considering both direct and indirect costs. Direct costs included additional payments for ambulatory care and dispensing fees that occurred under the new system. Indirect costs consisted of transportation expenses and costs related to time spent for physician consultation, waiting for the prescriptions to be filled, and extra traveling. Benefits identified in this study were the reduction of drug misuse and overuse, and the overall decrease in drug consumption among the Korean population. Sensitivity analysis was performed for the inclusion of benefits for outpatients of hospitals, price elasticity, and increased fees for established patients. RESULTS: The net benefit was estimated to be about minus 1,862 billion won and the benefit-cost ratio was 0.478. This indicates that the costs of 'Mandatory Prescription' outweigh its benefits, relative to the previous system. The sensitivity analysis results for all the variables considered in this study consistently showed the benefit-cost ratio to be less than 1. CONCLUSION: The results of this study suggest that implementing Mandatory Prescription System in Korea might be inefficient from the consumer's perspective. The results of this study do not coincide with the results of previous studies, presumably because of the differences in study design and in which items of costs and benefits were considered.; Summary

Cost-benefit Analysis of Massive Screening for Inborn Errors of Metabolism in Korea.: Chang Yup Kim, Sunmean Kim, Nami Hwang; Korean J Prev Med. 1999;32(3):317-324.

2,062 View
24 Download

Abstract PDF: OBJECTIVES
Since 1991, nationwide massive neonatal screen-ing program for phenylketonuria (PKU) and congenital hypothyroidism have been performed in Korea. As in many other countries, efficiency of this program has not been definitely concluded. For the purpose of evaluation of this program, from the perspective of efficiency, a cost-benefit analysis was carried out. METHODS: Costs of the detection and the treatment program were compared with the projected benefit(avoided costs) that results from the prevention of the mental retardation associated with the disorders due to PKU and hypothyroidism. Costs and benefits were discounted at an annual rate of 5 %, and duration of life-long labor was assumed to be 30 years. Cost and benefit were estimated based on the detection rates of one case of PKU per 5,572 and one case of congenital hypothyroidism per 32,554 babies screened during 1991-1997. RESULTS: The benefit-cost ratio was 0.418. The sensitivity analysis for the discount rates and labor durations showed that most cost-benefit ratios were lower than one(1.0) except when discount rate was changed to 3% and detection rate to two- or threefold and/or labor duration to 40 years. CONCLUSIONS: The result of this study suggested that present program of mass screening for PKU and congenital hypothyroidism could not be justified in terms of efficiency. It doesn't coincide with the results of previous studies in major developed countries, presumably because of difference in detection rates and welfare cost for the disabled.; Summary

Cost-Benefit Analysis of Back School Program for Occupational Low Back pain Patients.: Yeong Su Ju, Mi Na Ha, Sang Hwan Han, Ho Jang Kwon, Soo Hun Cho, Chang Yup Kim, Sun Min Kim; Korean J Prev Med. 1996;29(2):347-358.

2,178 View
30 Download

Abstract PDF: Although occupational low back pain accounts for 20~40% of all occupational illness and injury, there are limited numbers of studies regarding the effectiveness of back school program. The objective of this study was to evaluate the economic benefit of back school program for early return to work of occupational low back pain patients in the current occupational injury compensation and management system. The cost-benefit analysis in this study was conducted to evaluate the relative magnitude of benefit to cost. The total cost was estimated by calculating the value of components in back school program according to governmental budget protocol. The back school program was consisted of three major approaches, pain center, work-hardening program and functional restoration program and each of components had various facilities and experts. The total amount of cost was estimated as 250,866,220 won per year. The most promising type of back school program were quite intensive (a 3 to 5-week stay in a specialized center), therefore, if we adopted the 5-week stay course, 10 courses could be held in a year. Following to the medical act, 20 patients per doctor could participate in a each course, ie, total 200 patients in a year. As a result, we could estimate the cost of 1,254,331 won a patient. we estimated the benefit by using data of a few local labor offices about average medical treatment beneficiary and off-duty beneficiary of 46 occupational low back pain patients in 1994. Ullman and Larsson(1977) mentioned that the group of chronic low back pain patients who participated in back school program needed less time to recover by 48.4% of beneficiary duration. And in the trying to estimate the benefit, we asked 10 rehabilitation board certificate doctors about reduction proportion of treatment cost by introducing back school program. The answered reduction proportions were in the range of 30~45%, average 39%. As a final result, we could see that the introduction of back school program in treatment of chronic occupational low back pain patients could produce the benefit to cost ratio as 3.90 and 6.28. And we could conclude that the introduction of back school program was beneficial to current occupational injury compensation and management system.; Summary

Changes in Medical Practice Pattern before and after Covering Intraocular Lens in the Health Insurance.: No Ah Choi, Seung Hum Yu, Hey Young Min, Eun Wook Chung; Korean J Prev Med. 1994;27(4):807-814.

1,931 View
22 Download

Abstract PDF: This study is to find out changes in medical practice at a university hospital before and after covering intraocular lens (IOL) from the health insurance benefit. The coverage started on March 1, 1993 and a total of 596 cases who were discharged from July 1 to December 31, 1992 and 580 cases who were discharged from July 1 to December 31, 1993 were analyzed. Since the standard reimbursement scheme was changed from March 1, 1993, the charges for 1992 were transformed into 1993 scheme. Major findings are as follows: Average length of stay was statistically significantly decreased from 8.24 days in 1992 to 6 86 days in 1993. Charges except IOL has been statistically significantly decreased from 501,000 won in 1992 to 444,000 won in 1993. Charges for drugs and injection have been reduced. However, charge per day for them was not much different. This is due to decrease in length of stay. Charges for laboratory tests and radiologic examination were quite the same. charges which are not covered by the insurance remained the same. The revenue of the hospital was reduced as expected. However, the hospital reduced the length of stay and increase the turnover rate in order to compensate the potential loss of revenue due to the difference of reimbursement between the out-of-pocket expense and the insurance coverage. By introducing the IOL benefit in the insurance, the insured pays less, hospital generates more revenue through shortening the hospital stay, and the total medical care cost becomes less nationwidely.; Summary

Cost-Benefit Analysis on Rubella Vaccination Policy.: Young Jeon Shin, Bo Youl Choi, Hung Bae Park, Ok Ryun Moon, Bae Joong Yoon; Korean J Prev Med. 1994;27(2):337-365.

2,250 View
22 Download

Abstract PDF: Rubella is a viral disease with mild constitutional symptoms and generalized rashes ln childhood, it is an inconsequential illness, but when it occurs during early pregnant period, there are significant risks of heart defects, cataract, mental retardation to the fetus. The series of congenital defects induced by rubella is called 'congenital rubella syndrome'. Many research have been performed to find out more effective prevention program on rubella. The objectives of this study are, first, to calculate the incidence rate of acute rubella infection and congenital rubella syndrome in korea, second, to evaluate economic efficiency of several rubella vaccination policies and to offer data for the most reasonable decision on vaccination policy. Study populations are 663,312 children of one year-old in 1992. The author has performed cost-benefit analyses according to the three vaccination policies-U.S.A.'s. U.K's and Sweden's. In this study, the author got the incidence rate of acute rubella infection using the catalytic model. In the meantime, the author used 50 per 100,000 live births as the incidence rate of congenital rubella syndrome. The discount rate used in this study was 5 percent per annum. The sensitivity analyses were done with different discount rates (4%, 7%) and different incidence rate of congenital rubella syndrome (10,100 per 100,000 live births): The study results are as follows: 1. Without vaccination, lifetime expenditures per patient for acute rubella infection amount to 14,822 won and the total expenditures to about 3.1 billion won. Meanwhile, lifetime expenditures per patient for congenital rubella syndrome amount to about 91 million won and the total expenditures to about 16.3 billion won without vaccination. 2. The cost of vaccination for a child of one year old was 2,322 won and the total cost for the one year old children was about 1.5 billion won(American style). The cost for vaccination of female children at fifteen was about 339 million won (British style). And the cost of vaccination at one for both sex and female children at fifteen was about 1.9billion won (Swedish style). 3. The benefit to cost ratios of vaccination or female children at fifteen that is the british mode of rubella vaccination, was 60.0 at the level of 80 % population coverage and 48.6 at 100% coverage. It shows much higher benefit to cost ratio than those of the other two vaccination policies. 4. Both net benefits of vaccination at one (American style) and that of vaccinations at one and fifteen (Swedish style) range from about 17.0 billion to 17.8 billion won, those were larger than that of vaccinations of female children at fifteen(British style, about 16.0 billion). 5. In marginal cost-benefit analysis of only additional program or revaccination, the benefit to cost ratios were 3.6(80% coverage rate) or 0.6 (100% coverage rate). It implies that additional program was less efficient or inefficient 6. In sensitively analysis with different discount rates (4% or 7%) and different incidence rates of congenital rubella syndrome (l0 or 100 per 100,000 live births), the benefit to cost ratios has fluctuated in wide range. However, all the ratios of vaccination of female children at fifteen were higher than those of the others. Even under the most conservative assumption, the benefit to cost ratios of all the rubella vaccination policies were higher than 3.3. In conclusion all the rubella vaccination policies found to be cost-effective and particularly the vaccination of female children at fifteen was strongly recommended.; Summary

The Economic Losses of Smoking.: Jong Ku Park, Kyu Sik Lee; Korean J Prev Med. 1989;22(4):528-541.

1,736 View
21 Download

Abstract PDF: The purpose of this study was to identify and measure the economic costs and benefits due to smoking in Korea. Cigarette smoking is a major cause of morbidity and mortality. In addition to the health risks of smoking, there are important economic consequences. A complete assessment of the economics of smoking requires evaluation of various health, economic, and intangible parameters, including benefits as well as costs of both the production and consumption of tobacco. In this article we focus on costs resulting from the health effects of smoking (expenditures for medical care and the value of productive output lost to morbidity, and premature mortality among smokers), since economic benefits from tobacco industry is offset by expenditures for purchasing tobacco. Two distinct methodologies will be applied to measure the economic costs of smoking cigarette, the human capital and willingness-to-pay approaches. This article used the former method. In 1985, total economic losses due to smoking was estimated as 505.7 billion won, which was composed of morbidity losses 64.9 billion won, mortality losses 429.1 billion won and indirect costs 11.7 billion won.; Summary

Economic Benefits of Implementing National Health Insurance by Measurement of Changes in the Consumer's Surplus.: Han Joong Kim, Hae Jong Lee; Korean J Prev Med. 1989;22(3):398-405.

1,872 View
23 Download

Abstract PDF: A change in the consumer's surplus was measured in order to evaluate the social benefit to be derived from expanding health insurance to the entire population. The most refined and correct way to measure a project's net benefit to society is to determine a change in the consumer's surplus. Benefits from introducing the health insurance program to the uninsured people can be classified into two elements. The first is the pricing-down effect(E1) which results from applying the insurance price system, which is lower than the actual price, to the uninsured patients. The second effect(E2) is a decrease in actual payment because an insured patient pays only a portion of the total medical bill(copayment). We collected medical price information from the data banks of 93 hospitals, and obtained information of medical utilization by referring to the results of other research and from data published by the Korean Medical Insurance Societies. The total net benefit was estimated as won214 billion, comprising the first effect(E1) of won57 billion and the second effect(E2) of won157 billion. The price elasticity of physician visits is less than that of hospital admissions; however, benefits from the increase in physician visits are greater than those from hospital admissions because there are considerably more of physician visits than hospital admissions. The sensitivity analysis also shows the conclusion that expansion of the health insurance program to the entire population would result in a positive net benefit. Therefore, we conclude that the National Health Insurance Program is socially desirable.; Summary

English Abstract

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.

2,343 View
59 Download

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

First
Prev
Page of 1
Next
Last

Search