Journal of Preventive Medicine and Public Health

Brief Report

Characteristics and Health Care Spending of Persistently and Transiently High-cost Older Adults in Korea: Sungchul Park, Giryeon Bae; J Prev Med Public Health. 2023;56(5):475-480. Published online September 4, 2023; DOI: https://doi.org/10.3961/jpmph.23.270

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Abstract Summary PDF: Objectives
This study examined differences in health care spending and characteristics among older adults in Korea by high-cost status (persistently, transiently, and never high-cost).
Methods
We identified 1 364 119 older adults using data from the Korean National Insurance Claims Database for 2017-2019. Outcomes included average annual total health care spending and high-cost status for 2017-2019. Linear regression was used to estimate differences in the outcomes while adjusting for individual-level characteristics.
Results
Persistently and transiently high-cost older adults had higher health care spending than never high-cost older adults, but the difference in health care spending was greater among persistently high-cost older adults than among transiently high-cost older adults (US$20 437 vs. 5486). Despite demographic and socioeconomic differences between transiently high-cost and never high-cost older adults, the presence of comorbid conditions remained the most significant factor. However, there were no or small differences in the prevalence of comorbid conditions between persistently high-cost and transiently high-cost older adults. Rather, notable differences were observed in socioeconomic status, including disability and receipt of Medical Aid.
Conclusions
Medical risk factors contribute to high health care spending to some extent, but social risk factors may be a source of persistent high-cost status among older adults in Korea.; Summary

Korean summary
- 한국에서 65세 이상의 고령층 고비용 환자 그룹 내에서 두 개의 이질적인 그룹을 발견하였다. - 지속적으로 고비용인 환자는 일시적으로 고비용인 환자보다 의료비 지출이 유의미하게 더 많았다. - 두 그룹의 특성을 비교한 결과, 건강요인의 차이도 있었지만 그보다는 사회적 요인의 차이가 더 컸다.

Key Message
- High-cost older adults are heterogeneous in terms of health care spending and sample characteristics in Korea. - Persistently high-cost older adults had significantly higher health care spending than transiently high-cost older adults. - Medical risk factors contribute to high health care spending to some extent, but social risk factors may be a source of persistent high-cost status among older adults.

Original Articles

Identifying, Measuring, and Ranking Social Determinants of Health for Health Promotion Interventions Targeting Informal Settlement Residents: Farhad Nosrati Nejad, Mohammad Reza Ghamari, Seyed Hossein Mohaqeqi Kamal, Seyed Saeed Tabatabaee; J Prev Med Public Health. 2023;56(4):327-337. Published online June 26, 2023; DOI: https://doi.org/10.3961/jpmph.23.059

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Abstract PDF: Objectives
Considering the importance of social determinants of health (SDHs) in promoting the health of residents of informal settlements and their diversity, abundance, and breadth, this study aimed to identify, measure, and rank SDHs for health promotion interventions targeting informal settlement residents in a metropolitan area in Iran.
Methods
Using a hybrid method, this study was conducted in 3 phases from 2019 to 2020. SDHs were identified by reviewing studies and using the Delphi method. To examine the SDHs among informal settlement residents, a cross-sectional analysis was conducted using researcher-made questionnaires. Multilayer perceptron analysis using an artificial neural network was used to rank the SDHs by priority.
Results
Of the 96 determinants identified in the first phase of the study, 43 were examined, and 15 were identified as high-priority SDHs for use in health-promotion interventions for informal settlement residents in the study area. They included individual health literacy, nutrition, occupational factors, housing-related factors, and access to public resources.
Conclusions
Since identifying and addressing SDHs could improve health justice and mitigate the poor health status of settlement residents, ranking these determinants by priority using artificial intelligence will enable policymakers to improve the health of settlement residents through interventions targeting the most important SDHs.; Summary

Social and Policy Determinants of COVID-19 Infection Across 23 Countries: An Ecological Study: Kyungsik Kim, Young-Do Jeung, Jeoungbin Choi, Sue K. Park; J Prev Med Public Health. 2022;55(2):144-152. Published online February 10, 2022; DOI: https://doi.org/10.3961/jpmph.21.396

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Abstract Summary PDF Supplementary Material

Objectives
This study aimed to identify the social and policy determinants of coronavirus disease 2019 (COVID-19) infection across 23 countries.
Methods
COVID-19 indicators (incidence, mortality, and fatality) for each country were calculated by direct and indirect standardization. Multivariable regression analyses were used to identify the social and policy determinants of COVID-19 infection.
Results
A higher number of doctors per population was related to lower incidence, mortality, and fatality rates of COVID-19 in 23 countries (β=-0.672, -0.445, and -0.564, respectively). The number of nurses/midwives per population was associated with lower mortality and fatality rates of COVID-19 in 23 countries (β=-0.215 and -0.372, respectively). Strengthening of policy restriction indicators, such as restrictions of public gatherings, was related to lower COVID-19 incidence (β=-0.423). A national Bacillus Calmette–Guérin vaccination policy conducted among special groups or in the past was associated with a higher incidence of COVID-19 in 23 countries (β=0.341). The proportion of the elderly population (aged over 70 years) was related to higher mortality and fatality rates (β=0.209 and 0.350, respectively), and income support was associated with mortality and fatality rates (β=-0.362 and -0.449, respectively).
Conclusions
These findings do not imply causality because this was a country-based correlation study. However, COVID-19 transmission can be influenced by social and policy determinants such as integrated health systems and policy responses to COVID-19. Various social and policy determinants should be considered when planning responses to COVID-19.

Summary

Korean summary
본 연구는 23개국의 코로나 19 감염 지표 (발생, 사망, 치명)과 관련있는 사회적, 정책적 요소를 확인하고자 하는생태학적 연구이다. 이는 코로나 19 감염 지표에 대한 인과성을 제시하는 연구가 아니기에 주의 깊은 해석이 필요하며 본 연구에서 제시한 사회적, 정책적 요소를 통해 코로나 19 감염에 대한 국가적인 정책을 고려할 수 있을 것으로 기대된다.

Citations

Citations to this article as recorded by

COVID 19 mortality as a reflection of the quality of health in EU countries
Beáta Stehlíková, Zuzana Vincúrová, Ivan Brezina, Ilona Švihlíková
Economics & Sociology.2023; 16(3): 138. CrossRef
Social and Policy Determinants of COVID-19
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
Journal of Preventive Medicine and Public Health.2022; 55(3): 307. CrossRef
Social and Policy Determinants of COVID-19 Infection Across 23 Countries: An Ecological Study
Kyungsik Kim, Sue K. Park
Journal of Preventive Medicine and Public Health.2022; 55(3): 308. CrossRef
Country-level and regional COVID-19 burden and determinants across OECD member states and partner countries
Nlandu Roger Ngatu, Kazuto Tayama, Kanae Kanda, Tomohiro Hirao
Environmental Health and Preventive Medicine.2022; 27: 41. CrossRef
The association between tobacco or nicotine product use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic: a cross-sectional study in Korea
Da-eun Lee, Heewon Kang, Sung-il Cho
Epidemiology and Health.2022; 44: e2022087. CrossRef

Scoping Review

The Most Important Social Determinants of Slum Dwellers’ Health: A Scoping Review: Farhad Nosrati Nejad, Mohammad Reza Ghamari, Seyed Hossein Mohaqeqi Kamal, Seyed Saeed Tabatabaee, Raheleh Ganjali; J Prev Med Public Health. 2021;54(4):265-274. Published online July 8, 2021; DOI: https://doi.org/10.3961/jpmph.21.073

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220 Download
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Abstract PDF

Objectives
Given the importance of social determinants of health in promoting the health of slum residents, this study was conducted with the aim of identifying the main dimensions and components of these determinants.
Methods
This scoping review study was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive search was performed of PubMed, ProQuest, Scopus, and Web of Science for articles conducted from 2010 to the end of 2019. Studies were selected based on inclusion criteria, with a special focus on studies dealing with the social determinants of physical and mental health or illness.
Results
Thirty-three articles were selected to extract information on the social determinants of health. After reviewing the articles, 7 main dimensions (housing, socioeconomic status of the family, nutrition, neighborhood characteristics, social support and social capital, occupational factors, and health behaviors) and 87 components were extracted as social determinants of health among slum dwellers.
Conclusions
This framework could be used by planners, managers, and policy-makers when making decisions affecting the health of these settlements’ residents due to the common characteristics of slums around the world, especially in developing countries.

Summary

Citations

Citations to this article as recorded by

Deprivation and Its Association with Child Health and Nutrition in the Greater Kampala Metropolitan Area of Uganda
Rornald Muhumuza Kananura, Peter Waiswa, Ronald Wasswa, Ties Boerma, Cauane Blumenberg, Abdoulaye Maiga
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Edem Yaw Zigah, Gamji Rabiu Abu-Ba'are, Osman Wumpini Shamrock, Henry Delali Dakpui, Amos Apreku, Donte T. Boyd, LaRon E. Nelson, Kwasi Torpey
Health & Place.2023; 83: 103076. CrossRef
Identifying, Measuring, and Ranking Social Determinants of Health for Health Promotion Interventions Targeting Informal Settlement Residents
Farhad Nosrati Nejad, Mohammad Reza Ghamari, Seyed Hossein Mohaqeqi Kamal, Seyed Saeed Tabatabaee
Journal of Preventive Medicine and Public Health.2023; 56(4): 327. CrossRef
Do Community-based Livelihood Interventions Affect Sexual and Reproductive Health and Rights of Young People in Slum Areas of Uganda: a Difference-in-difference with Kernel Propensity Score Matching Analysis
Andre M. N. Renzaho, Joseph K. Kamara, Daniel Doh, Paul Bukuluki, Rashidul A. Mahumud, Moses Galukande
Journal of Urban Health.2022; 99(1): 164. CrossRef

COVID-19: Original Article

Social Determinants of COVID-19 in Massachusetts, United States: An Ecological Study: Devan Hawkins; J Prev Med Public Health. 2020;53(4):220-227. Published online June 24, 2020; DOI: https://doi.org/10.3961/jpmph.20.256

7,507 View
350 Download
62 Crossref

Abstract PDF Supplementary Material

Objectives
The aim of this study was to assess how different social determinants of health (SDoH) may be related to variability in coronavirus disease 2019 (COVID-19) rates in cities and towns in Massachusetts (MA).
Methods
Data about the total number of cases, tests, and rates of COVID-19 as of June 10, 2020 were obtained for cities and towns in MA. The data on COVID-19 were matched with data on various SDoH variables at the city and town level from the American Community Survey. These variables included information about income, poverty, employment, renting, and insurance coverage. We compared COVID-19 rates according to these SDoH variables.
Results
There were clear gradients in the rates of COVID-19 according to SDoH variables. Communities with more poverty, lower income, lower insurance coverage, more unemployment, and a higher percentage of the workforce employed in essential services, including healthcare, had higher rates of COVID-19. Most of these differences were not accounted for by different rates of testing in these cities and towns.
Conclusions
SDoH variables may explain some of the variability in the risk of COVID-19 across cities and towns in MA. Data about SDoH should be part of the standard surveillance for COVID-19. Efforts should be made to address social factors that may be putting communities at an elevated risk.

Summary

Citations

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Original Article

Contextual and Individual Determinants of Mental Health: A Cross-sectional Multilevel Study in Tehran, Iran: Homeira Sajjadi, Gholamreza Ghaedamini Harouni, Hassan Rafiey, Mohammadreza Vaez-Mahdavi, Meroe Vameghi, Seyed Hossein Mohaqeqi Kamal; J Prev Med Public Health. 2020;53(3):189-197. Published online April 14, 2020; DOI: https://doi.org/10.3961/jpmph.19.150

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Abstract PDF

Objectives
Our aim was to answer the following questions: (1) Can mental health variance be partitioned to individual and higher levels (e.g., neighborhood and district); (2) How much (as a percentage) do individual-level determinants explain the variability of mental health at the individual-level; and (3) How much do determinants at the neighborhood- or district-level explain the variability of mental health at the neighborhood- or district-level?
Methods
We used raw data from the second round of the Urban Health Equity Assessment and Response Tool in Tehran (in 2012-2013, n=34 700 samples nested in 368 neighborhoods nested in 22 districts) and the results of the official report of Tehran’s Center of Studies and Planning (in 2012-2013, n=22 districts). Multilevel linear regression models were used to answer the study questions.
Results
Approximately 40% of Tehran residents provided responses suggestive of having mental health disorders (30-52%). According to estimates of residual variance, 7% of mental health variance was determined to be at the neighborhood-level and 93% at the individual-level. Approximately 21% of mental health variance at the individual-level and 49% of the remaining mental health variance at the neighborhood-level were determined by determinants at the individual-level and neighborhood-level, respectively.
Conclusions
If we want to make the most effective decisions about the determinants of mental health, in addition to considering the therapeutic perspective, we should have a systemic or contextual view of the determinants of mental health.

Summary

Citations

Citations to this article as recorded by

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Seyed Hossein Mohaqeqi Kamal, Mehdi Basakha, Sabina Alkire
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Parental Objective, Subjective, and Contextual Socioeconomic Status and Children's Mental Health in Iran: The Mediating Effect of the Subjective Measure
Ardavan Mohammad Aghaei, Lawrence Wissow, Ramin Mojtabai, Hadi Zarafshan, Zahra Shahrivar, Amir Hossein Nikzad, Vandad Sharifi
Iranian Journal of Psychiatry and Behavioral Sciences.2023;[Epub] CrossRef
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Research Support, Non-U.S. Gov't

Participation Determinants in the DRG Payment System of Obstetrics and Gynecology Clinics in South Korea.: Jung Kook Song, Chang yup Kim; J Prev Med Public Health. 2010;43(2):117-124.; DOI: https://doi.org/10.3961/jpmph.2010.43.2.117

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Abstract PDF

OBJECTIVES
The Diagnosis Related Group (DRG) payment system, which has been implemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. METHODS: The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. RESULTS: The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (p<0.05): (1) a larger number of caesarian section (c/sec) claims, (2) higher cost of a c/sec, (3) less variation in the price of a c/sec, (4) fewer days of admission for a c/sec, and (5) younger pregnant women undergoing a c/sec. CONCLUSIONS: These results suggest that OBGYN clinics with an economic practice pattern under a fee-for-service system are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.

Summary

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Tae Ik Chang, Haeyong Park, Dong Wook Kim, Eun Kyung Jeon, Connie M. Rhee, Kamyar Kalantar-Zadeh, Ea Wha Kang, Shin-Wook Kang, Seung Hyeok Han
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Jae-Woo Choi, Sung-In Jang, Suk-Yong Jang, Seung-Ju Kim, Hye-Ki Park, Tae Hyun Kim, Eun-Cheol Park
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Journal of Korean Academy of Nursing Administration.2012; 18(2): 176. CrossRef

English Abstract

Determinants of Sterilization among Married Couples in Korea.: Ju Hee Kim, Woojin Chung, Sunmi Lee, Moonhee Suh, Dae Ryong Kang; J Prev Med Public Health. 2007;40(6):461-466.; DOI: https://doi.org/10.3961/jpmph.2007.40.6.461

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Abstract PDF: OBJECTIVES
The purpose of this study was to examine the determinants of sterilization in South Korea. METHODS: This study was based on the data from the Korea National Fertility Survey carried out in the year 2000 by the Korea Institute of Health and Social Affairs. The subjects of the analysis were 4,604 women and their husbands who were in their first marriage, in the age group of 15-49 years. The data were analyzed by multiple logistic regression analysis. RESULTS: Consistent with the findings of previous studies, the woman's age and the number of total children increased the likelihood of sterilization. In addition, the year of marriage had a strong positive association with sterilization. Interestingly, the number of surviving sons tended to increase the likelihood of sterilization, whereas the woman's education level and age at the time of marriage showed a negative association with sterilization. Religion, place of residence, son preference, and the husband's education level, age and type of occupation were not significant determinants of sterilization. CONCLUSIONS: The sex of previous children and lower level of education are distinct determinants of sterilization among women in South Korea. More studies are needed in order to determine the associations between sterilization rate and decreased fertility.; Summary

Original Articles

Predictors of Smoking Cessation in Outpatients.: Yune Sik Kang, Jang Rak Kim, Joung Soon Jang, Young Sil Hwang, Dae Yong Hong; Korean J Prev Med. 2003;36(3):248-254.

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Abstract PDF: OBJECTIVE
This study was conducted in order to investigate predictors of smoking cessation in outpatients. METHOD: Subjects were 401 adult smoking patients who saw their doctors in the outpatient setting at a university hospital, regardless of their willingness of otherwise in smoking cessation. Physicians delivered a brief, stop smoking prompt to all patients who smoked one or more cigarettes a day. Then they referred to on-site counselors who provided a brief, nurse assisted intervention with a survey to a randomly assigned intervention group (200 smoking patients), whom the counselors telephoned later to prevent relapse or promote the motivation to quit, or gave only a survey to a control group (201 smoking patients). After at least 5 months, self-reported current smoking cessation was confirmed later using cut-off values of 7 ppm or less in expired alveolar air after breath holding portable CO analyzer. RESULTS: After 5 months, subjects in the intervention group were 1.56 times (95% C.I. 0.89-2.73) more likely to quit smoking than those in the non-intervention group (14.0% vs. 9.0%). Willingness to quit smoking in a month, scheduled admission in a month, self efficacy score and FTND (Fagerstrom Test for Nicotine Dependence) score were all significantly related with smoking cessation. In stepwise multiple logistic regression, previous attempts to quit smoking were significant instead of self efficacy score. In the intervention group who had willingness to quit smoking in a month (132 smoking patients), FTND score, whether quit date was today, and whether quit promise paper was submitting were all significantly related with smoking cessation. In stepwise multiple logistic regression, scheduled admission in a month and whether quit date was today were significant predictor variables. Smoking cessation treatment should be tailored to individual smoking patients considering these predictors.; Summary

Determinanats of Health Care Utilization of the Physically Disabled.: Keon Yeop Kim, Young Sook Lee, Ki Soo Park, Jae Hee Son, Sin Kam, Byung Yeol Chun, Jae Yong Park, Min Hae Yeh; Korean J Prev Med. 1998;31(2):323-334.

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Abstract PDF: To investigate determinants of health care utilization of the physically, disabled over 20 years old in age living in Taegu city, a self-administered questionnaire survey was carried out for 337 disabled persons with chronic illness from April to July, 1997. Health care utilization rate was 81.9%(69.l% for hospital or clinic and 12.8% for pharmacy). Marital status, job, health concern, and response to illness showed statistically, significant relationship with health care utilization(p<0.05). By, path analysis, job, economic status, medical security type and response to illness had a significant direct effect on health care utilization(p<0.05), however, health concern and regular source of care had an indirect effect. The reasons of no health utilization were due to economic problem(31.l%), no symptom(18.0%), inconvenience to seek care or no accompanying persons to be helped(14.8%), unseriousness of the severity of the illness(14.8%), too busy to be treated or no free time(8.2%), hopeless prognosis to be treated(6.6%) in order. In conclusion, it is recommended that the program for expanding medicaid, improving socioeconomic status by getting a job and health education to increase the health Concern toward physically disabled should be implemented to increase health care utilization rate.; Summary

Drug Abuse Status and Its Determinants of Male High School Students in Taegu.: Jung Rak Nam, Sin Kam, Jae Yong Park, Chang Hyun Han, Young Ae Ha; Korean J Prev Med. 1996;29(3):451-470.

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Abstract PDF: To identify the drug abuse status and its determinant factors in high school boys in Taegu, the study was performed from April to May, 1995. Study population were selected by cluster sampling method and total 5,665 students replied to the self-administered questionnaire survey(2,207 in academic high school, 3,458 in business high school). The major findings were as follows; The proportion of drinking, smoking experience was 55.0%, 45.8%, respectively, and the proportion of current drinker, current smoker was 27.2%, 27.5%. The drinking, smoking experience rate of second grade students was higher than first grade and it was higher in business high school boys. The proportion of a stimulant, a hallucinogen, hemp leaf cigarets experience was 3.2%, 1.6%, 0.1%, respectively. Drug abuse had significant association with home environment(lower economic status, frequent move, death of father or mother, apart from family), parents environment(parents' indifference, parents' drinking and smoking, etc.), school life(lower school grades, intimate friend's drug abuse, etc.), generous attitude to drug abuse, higher level of stress. Students who replied that the law prohibited immature person(students) from drinking and smoking showed lower drug abuse rate. In multiple logistic regression analysis, second grade students, business high school students, parents' indifference, lower school grades, intimate friend's drug abuse, no recognition of the fact that the law prohibits high school students from drinking and smoking, generous attitude to drug abuse, higher level of stress were significantly related with alcohol abuse and smoking. Other drugs abuse were related with above factors. On consideration of above findings, to prevent students from drug abuse, we have to try together in house, school, and society.; Summary

A Comparative Study on Medical Utilization between Urban and Rural Korea.: Kyungshik Joo, Hanjoong Kim, Sunhee Lee, Hyeyoung Min; Korean J Prev Med. 1996;29(2):311-330.

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Abstract PDF: This study was designed to compare the level of medical utilization between the urban and rural areas of Korea and to explain the differences between the two regions. Data from the National Health Interview survey performed by the korean Institute of Health & social Affairs in 1992 were used for this study utilizing a sample size of 21,841 people. The level of medical utilization such as the number of physician visits and the number of hospital admissions was compared between the regions with ANOVA. Various determinants for medical use were also compared by univariate analysis. Statistical models which included enabling factors, predisposing factors, need factors and region were constructed for bivariate analysis in order to further elucidate the level of medical utilization. The results were as follows: 1. There was greater medical use, both in terms of physician visits and inpatient care in the rural areas in spite of insufficient health resources. The particular reasons for higher medical utilization in rural areas were attributed to a higher number of initial physician visits as well as a longer the length of stay per hospital admission. Therefore, indicators representing the degree of met need (utilization/need) showed no significant difference between rural and urban areas in spite of the fact that the medical need is larger in rural areas. 2. Use of public health facilities received a significant portion of physician visits in the rural area. The government's effort to enhance primary health care through health centers, health subcenters and the nurse practitioner's post in rural areas has contributed to the increase of access to medical care in the rural areas. 3. There were some differences in the socio-demographic characteristics between two regions; There were more elderly people over the age of 65; unstable marital status, less education and lower incomes also characterized the rural areas. Therefore, among rural people, there were more predisposing factors for medical use. Additionally, need factors such as poor self-reported health status and high morbidity level were also high in the rural area. 4. In contrast it was learned that, the supply of health resources was mostly concentrated in the urban areas except for public health facilities. Therefore, geographical access to medical care was lower in the rural area both in terms travel time and travel cost. 5. The coefficient of the region variable was insignificant in the regression model which controlled the supply factor only However, utilization was significantly higher in urban areas if the model included predisposing factors and need factors in addition to the supply factor. The results were interpreted as rural people have greater medical needs.; Summary

Regional Variations in the Cesarean Section Rate and It's Determinants in Korea.: Hye Kyung Kim, Jeon Un Lee, Kang Won Park, Ok Ryun Moon; Korean J Prev Med. 1992;25(3):312-329.

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Abstract PDF: The purpose of this study is to estimate cesarean section rate in Korea and analyze the socioeconomic variables and health resources which affect regional variation in the rate. Samples were drawn from the record of vaginal and cesarean section deliveries based upon insurance claim bills which have been submitted to the National Federation of Medical Insurance for the first three months, January through March, 1991. The results are obtained as follows: It was found that, cesarean section rate was increasing rapidly up to 23.1% in 1991. Cesarean section per 10 thousand insured people was 4.8 and the number of cesarean section per 10 thousand insured eligible(15-49 years old) female was 7.6. The fee for normal delivery was 109,489 won and that for cesarean section was 390,024 won. The average days of hospitalization in normal delivery was 2.3 days, and those in cesarean section was 7.6 days. On the average cesarean section has a longer of stay as much as by 4.3 days and cost 3.6 times more than normal deliveries. Cesarean section rates vary among medical facilities: 19.8% at clinics 37.6% in small-scale hospitals, and 29.1% in general hospitals. The regional variation of cesarean section rates was also fairly prominent. The South Cheju Gun has the highest rate of cesarean section, 56.2%. Meanwhile no cesarean section cases has been reported in Sunchang Gun during the period of this study. The variation is noted among provinces. The rate for Cheju province has been 3.4 times higher than that for Chunnam. The number of cesarean section per 10 thousand insured people vary greatly among regions, too. This study has found that there exists significant regional variations among various geographic units in terms of average length of stay, average cost, number of obsretricians and number of beds. Multiple regression analysis was done to identify factors explaining the regional variance of various cesarean section rates: In the urban areas, no significant explaining variables were noted except the number of beds for the dependent variable of cesarean section cases per 10 thousand insured eligible females. The smaller the number of bed, the more cases of cesarean section was noted for an urban area. The is mostly because the rate of cesarean section is higher in medium-size hospitals than in large general hospitals. In the rural areas, the factor of education has been found significant for all three dependent variables. The higher the educational level, the rate of cesarean section is most likely to rise. An income variable measured by the amount of monthly insurance contribution has been identified a powerful predictor in explaining the variance of cesarean section rates. The same has been noted for the number of obstetricians. Similar findings are observed for the country as a whole. The income level has been found as the most powerful explaining factor in the regional variance of cesarean section rates. In general the rate is higher in the urban areas, and lower in the area with more small hospitals. As this is the initial attempt to identify the factors relevant to the regional difference in the rates of cesarean section, more elaborated study is urgently required.; Summary

Physician Utilization and its Determinants in Rural and Urban Slun Areas.: Jin Hee Lee, Kee Ho Ko, Yong Sik Kim, Jung Ae Rhee; Korean J Prev Med. 1988;21(2):404-418.

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Abstract PDF: The household survey was performed in a urban slum and a rural Chonnam areas to measure the level of illness and medical care utilization and to find the determinants of physician utilization. The data revealed that age-adjusted prevalence rates of acute and chronic diseases were much the same in both areas ranged between 10.0 to 11.3%. But medical care utilization was more frequent in urban slum than in rural area. The facility of the first medical contact was also different. Some personal and disease related variables including disease severity and activity restricted day were significantly, but somewhat differently by area, associated with physician utilization pattern. When applying Anderson model, the medical need factors explained 42.2 and 40.4% of physician utilization in urban slum and in rural areas respectively, while the enabling factors explained 18.0 and 12.2% and the predisposing factors explained 17.1 and 8.9% correspondingly.; Summary

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