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Perspective
The Paradox of the Ugandan Health Insurance System: Challenges and Opportunities for Health Reform
Emmanuel Otieno, Josephine Namyalo
J Prev Med Public Health. 2024;57(1):91-94.   Published online December 30, 2023
DOI: https://doi.org/10.3961/jpmph.23.110
  • 820 View
  • 81 Download
AbstractAbstract AbstractSummary PDF
For nearly four decades, Ugandans have experienced a period marked by hope, conflict, and resilience across various aspects of healthcare reform. The health insurance system in Uganda lacks a legal framework and does not extend benefits to the entire population. In Uganda, community-based health insurance is common among those in the informal sector, while private medical insurance is typically provided to employees by their workplaces and agencies. The National Health Insurance Scheme Bill, introduced in 2019, was passed in 2021. If the President of Uganda gives his assent to the National Health Insurance Bill, it will become a significant policy driving health and universal health coverage. However, this bill is not without its shortcomings. In this perspective, we aim to explore the complex interplay of challenges and opportunities facing Uganda’s health sector.
Summary
Key Message
For the Ugandans, nearly the last four decades have been years of hope, conflict, and resilience in a myriad of contexts for healthcare reform. Health insurance system has no legal framework and provides benefits not to the entire national population. The 2019 National Health Insurance scheme Bill was passed in 2021. If the President of Uganda assents to the National Health Insurance Bill, it will be a compelling policy in health and health for all policies. But this Bill has several drawbacks. In this perspective, we aimed to provide intricacies and mix of challenges and opportunities for the health sector.
Systematic Review
Adjusting for Confounders in Outcome Studies Using the Korea National Health Insurance Claim Database: A Review of Methods and Applications
Seung Jin Han, Kyoung Hoon Kim
J Prev Med Public Health. 2024;57(1):1-7.   Published online November 16, 2023
DOI: https://doi.org/10.3961/jpmph.23.250
  • 1,526 View
  • 191 Download
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
Adjusting for potential confounders is crucial for producing valuable evidence in outcome studies. Although numerous studies have been published using the Korea National Health Insurance Claim Database, no study has critically reviewed the methods used to adjust for confounders. This study aimed to review these studies and suggest methods and applications to adjust for confounders.
Methods
We conducted a literature search of electronic databases, including PubMed and Embase, from January 1, 2021 to December 31, 2022. In total, 278 studies were retrieved. Eligibility criteria were published in English and outcome studies. A literature search and article screening were independently performed by 2 authors and finally, 173 of 278 studies were included.
Results
Thirty-nine studies used matching at the study design stage, and 171 adjusted for confounders using regression analysis or propensity scores at the analysis stage. Of these, 125 conducted regression analyses based on the study questions. Propensity score matching was the most common method involving propensity scores. A total of 171 studies included age and/or sex as confounders. Comorbidities and healthcare utilization, including medications and procedures, were used as confounders in 146 and 82 studies, respectively.
Conclusions
This is the first review to address the methods and applications used to adjust for confounders in recently published studies. Our results indicate that all studies adjusted for confounders with appropriate study designs and statistical methodologies; however, a thorough understanding and careful application of confounding variables are required to avoid erroneous results.
Summary
Korean summary
건강보험청구자료를 사용한 성과연구에서는 교란요인 통제가 중요하다. 최근 발표된 연구들은 연구설계와 통계 분석 과정에 적절하게 교란요인을 통제하였다. 연구의 질을 높이기 위해서는 건강보험청구자료에서 수집 가능한 교란 요인에 대한 이해와 방법론적 가이드라인이 요구된다.
Key Message
All recently published studies using Health Insurance Claims Database adjusted for confounders with appropriate study designs and statistical methodologies. The review suggests the need for careful application of confounding variables and the methodological guidance to improve the quality of outcome studies.

Citations

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  • Worsening of health disparities across COVID-19 pandemic stages in Korea
    Hyejin Lee, Hyunwoo Nam, Jae-ryun Lee, Hyemin Jung, Jin Yong Lee
    Epidemiology and Health.2024; : e2024038.     CrossRef
  • Trends in Regional Disparities in Cardiovascular Surgery and Mortality in Korea: A National Cross-sectional Study
    Dal-Lae Jin, Kyoung-Hoon Kim, Euy Suk Chung, Seok-Jun Yoon
    Journal of Preventive Medicine and Public Health.2024; 57(3): 260.     CrossRef
Original Article
Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study
Yeong Geun Gwon, Seung Jin Han, Kyoung Hoon Kim
J Prev Med Public Health. 2023;56(3):248-254.   Published online April 12, 2023
DOI: https://doi.org/10.3961/jpmph.23.015
  • 1,649 View
  • 92 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care.
Methods
Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients’ characteristics over time, and significant changes in the rates were identified by joinpoint regression.
Results
The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic.
Conclusions
The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.
Summary
Korean summary
본 연구에서는 급성심근경색증과 뇌졸중 치명률, 외래진료 민감질환의 예방 가능한 입원율을 사용하여 한국의 의료 질 수준을 분석하였다. 2008~2020년 동안 치명률과 예방 가능한 입원율은 감소하는 추세이다. 그러나, 예방 가능한 입원율은 다른 국가에 비해 상대적으로 높아 환자의 건강결과 향상을 위하여 일차의료 강화가 요구된다.

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  • Mortality and Disparities of Acute Myocardial Infarction and Stroke in Korea, 2008–2019
    Ji-Sook Choi, Soomin Kim, Choon-Seon Park, Hyejin Lee, Jin Yong Lee, Sun Min Kim
    Yonsei Medical Journal.2024;[Epub]     CrossRef
COVID-19: Special Article
COVID-19 International Collaborative Research by the Health Insurance Review and Assessment Service Using Its Nationwide Real-world Data: Database, Outcomes, and Implications
Yeunsook Rho, Do Yeon Cho, Yejin Son, Yu Jin Lee, Ji Woo Kim, Hye Jin Lee, Seng Chan You, Rae Woong Park, Jin Yong Lee
J Prev Med Public Health. 2021;54(1):8-16.   Published online January 26, 2021
DOI: https://doi.org/10.3961/jpmph.20.616
  • 4,723 View
  • 202 Download
  • 10 Web of Science
  • 9 Crossref
AbstractAbstract PDF
This article aims to introduce the inception and operation of the COVID-19 International Collaborative Research Project, the world’s first coronavirus disease 2019 (COVID-19) open data project for research, along with its dataset and research method, and to discuss relevant considerations for collaborative research using nationwide real-world data (RWD). COVID-19 has spread across the world since early 2020, becoming a serious global health threat to life, safety, and social and economic activities. However, insufficient RWD from patients was available to help clinicians efficiently diagnose and treat patients with COVID-19, or to provide necessary information to the government for policy-making. Countries that saw a rapid surge of infections had to focus on leveraging medical professionals to treat patients, and the circumstances made it even more difficult to promptly use COVID-19 RWD. Against this backdrop, the Health Insurance Review and Assessment Service (HIRA) of Korea decided to open its COVID-19 RWD collected through Korea’s universal health insurance program, under the title of the COVID-19 International Collaborative Research Project. The dataset, consisting of 476 508 claim statements from 234 427 patients (7590 confirmed cases) and 18 691 318 claim statements of the same patients for the previous 3 years, was established and hosted on HIRA’s in-house server. Researchers who applied to participate in the project uploaded analysis code on the platform prepared by HIRA, and HIRA conducted the analysis and provided outcome values. As of November 2020, analyses have been completed for 129 research projects, which have been published or are in the process of being published in prestigious journals.
Summary

Citations

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  • Symptoms and Conditions in Children and Adults up to 90 Days after SARS-CoV-2 Infection: A Retrospective Observational Study Utilizing the Common Data Model
    Minjung Han, Taehee Chang, Hae-ryoung Chun, Suyoung Jo, Yeongchang Jo, Dong Han Yu, Sooyoung Yoo, Sung-il Cho
    Journal of Clinical Medicine.2024; 13(10): 2911.     CrossRef
  • Data Resource Profile: Health Insurance Review and Assessment Service Covid-19 Observational Medical Outcomes Partnership (HIRA Covid-19 OMOP) database in South Korea
    Chungsoo Kim, Dong Han Yu, Hyeran Baek, Jaehyeong Cho, Seng Chan You, Rae Woong Park
    International Journal of Epidemiology.2024;[Epub]     CrossRef
  • Effect of changes in the hearing aid subsidy on the prevalence of hearing loss in South Korea
    Chul Young Yoon, Junhun Lee, Tae Hoon Kong, Young Joon Seo
    Frontiers in Neurology.2023;[Epub]     CrossRef
  • Scalable Infrastructure Supporting Reproducible Nationwide Healthcare Data Analysis toward FAIR Stewardship
    Ji-Woo Kim, Chungsoo Kim, Kyoung-Hoon Kim, Yujin Lee, Dong Han Yu, Jeongwon Yun, Hyeran Baek, Rae Woong Park, Seng Chan You
    Scientific Data.2023;[Epub]     CrossRef
  • Comparative risk of incidence and clinical outcomes of COVID-19 among proton pump inhibitor and histamine-2 receptor antagonist short-term users: a nationwide retrospective cohort study
    Jimyung Park, Seng Chan You, Jaehyeong Cho, Chan Hyuk Park, Woon Geon Shin, Rae Woong Park, Seung In Seo
    BMC Pharmacology and Toxicology.2022;[Epub]     CrossRef
  • Decreased patient visits for ankle sprain during the COVID-19 pandemic in South Korea: A nationwide retrospective study
    Youngsik Hwang, Dasom Kim, Sukhyun Ryu
    Preventive Medicine Reports.2022; 26: 101728.     CrossRef
  • Early Real-World Data to Assess Benefits and Risks of COVID-19 Vaccines: A Systematic Review of Methods
    Tatiane B. Ribeiro, Fátima Roque, Fidelia Ida, Ana I. Plácido, Mai Vu, Jose J. Hernández-Muñoz, Maria Teresa Herdeiro
    Vaccines.2022; 10(11): 1896.     CrossRef
  • Challenges in evaluating treatments for COVID-19: The case of in-hospital anticoagulant use and the risk of adverse outcomes
    Ya-Hui Yu, In-Sun Oh, Han Eol Jeong, Robert W. Platt, Antonios Douros, Ju-Young Shin, Kristian B. Filion
    Frontiers in Pharmacology.2022;[Epub]     CrossRef
  • Use of repurposed and adjuvant drugs in hospital patients with covid-19: multinational network cohort study
    Albert Prats-Uribe, Anthony G Sena, Lana Yin Hui Lai, Waheed-Ul-Rahman Ahmed, Heba Alghoul, Osaid Alser, Thamir M Alshammari, Carlos Areia, William Carter, Paula Casajust, Dalia Dawoud, Asieh Golozar, Jitendra Jonnagaddala, Paras P Mehta, Mengchun Gong, D
    BMJ.2021; : n1038.     CrossRef
Perspective
Dilemmas Within the Korean Health Insurance System
Donghwi Park, Min Cheol Chang
J Prev Med Public Health. 2020;53(4):285-288.   Published online July 1, 2020
DOI: https://doi.org/10.3961/jpmph.20.074
  • 4,426 View
  • 121 Download
  • 3 Crossref
AbstractAbstract PDF
The health insurance system in Korea is well-established and provides benefits for the entire national population. In Korea, when patients are treated at a hospital, the hospital receives a partial payment for the treatment from the patient, and the remaining amount is provided by the health insurance service. The Health Insurance Review and Assessment Service (HIRA) assesses whether the treatment was appropriate. If HIRA deems the treatment appropriate, the doctor can receive payment from the health insurance service. However, this system has several drawbacks. In this study, we aimed to provide examples of the problems that can occur in relation to HIRA assessments in Korea through actual clinical cases.
Summary

Citations

Citations to this article as recorded by  
  • The Paradox of the Ugandan Health Insurance System: Challenges and Opportunities for Health Reform
    Emmanuel Otieno, Josephine Namyalo
    Journal of Preventive Medicine and Public Health.2024; 57(1): 91.     CrossRef
  • Effect of Income Level on Stroke Incidence and Mediated Effects of Medication Adherence in Newly Diagnosed Hypertensive Patients: A Causal Mediation Analysis Using a Nationwide Cohort Study in South Korea
    Seungmin Jeong, So Yeon Kong, Seung-sik Hwang, Sung-il Cho
    Journal of Health Informatics and Statistics.2022; 47(4): 268.     CrossRef
  • Diagnosis of Duchenne Muscular Dystrophy in a Presymptomatic Infant Using Next-Generation Sequencing and Chromosomal Microarray Analysis: A Case Report
    Eun-Woo Park, Ye-Jee Shim, Jung-Sook Ha, Jin-Hong Shin, Soyoung Lee, Jang-Hyuk Cho
    Children.2021; 8(5): 377.     CrossRef
Original Articles
Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017
Akram Hernández-Vásquez, Carlos Rojas-Roque, Rodrigo Vargas-Fernández, Diego Rosselli
J Prev Med Public Health. 2020;53(4):266-274.   Published online June 10, 2020
DOI: https://doi.org/10.3961/jpmph.20.035
  • 4,629 View
  • 194 Download
  • 9 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017.
Methods
We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index.
Results
The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05).
Conclusions
Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.
Summary

Citations

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  • Causes of death among international travellers in Peru, 2017 to 2021
    Kasim Allel, Miguel M Cabada, Collen Lau, Deborah Mills, Richard C Franklin, Yan Zhu, Luis Furuya-Kanamori
    Journal of Travel Medicine.2024;[Epub]     CrossRef
  • Informal payments in health facilities in Peru in 2018: Analysis of a cross-sectional survey
    Laura Espinoza-Pajuelo, Patricia Mallma, Hannah Hogan Leslie, Patricia Jannet García, Sarthak Gaurav
    PLOS Global Public Health.2024; 4(1): e0001837.     CrossRef
  • An Examination of Inter-State Variation in Utilization of Healthcare Services, Associated Financial Burden and Inequality: Evidence from Nationally Representative Survey in India
    Aashima, Rajesh Sharma
    International Journal of Social Determinants of Health and Health Services.2024; 54(3): 206.     CrossRef
  • Consumer Financial Protection Versus Catastrophic Healthcare Expenditure in Zambia
    MccPowell Fombang, Richard Wamalwa Wanzala
    Public Health Challenges.2024;[Epub]     CrossRef
  • High cost drugs in Latin America: access and barriers
    Diego Rosselli
    Expert Review of Pharmacoeconomics & Outcomes Research.2023; 23(6): 619.     CrossRef
  • Prevalence and determinants of catastrophic healthcare expenditures in Iran from 2013 to 2019
    Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
    Journal of Preventive Medicine and Public Health.2023;[Epub]     CrossRef
  • Determinants of Eye Care Service Utilization among Peruvian Adults: Evidence from a Nationwide Household Survey
    Antonio Barrenechea-Pulache, Andres Portocarrero-Bonifaz, Akram Hernández-Vásquez, Carlos Portocarrero-Ramos, Jenny Moscoso-Carrasco
    Ophthalmic Epidemiology.2022; 29(3): 339.     CrossRef
  • Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature
    Taslima Rahman, Dominic Gasbarro, Khurshid Alam
    Health Research Policy and Systems.2022;[Epub]     CrossRef
  • THE IGNORED PANDEMIC OF PUBLIC HEALTH CORRUPTION: A CALL FOR ACTION AMID AND BEYOND SARS-COV-2/COVID-19
    Jorge A. Sánchez-Duque, Zhaohui Su, Diego Rosselli, Maria Camila Chica-Ocampo, Maria Isabel Lotero-Puentes, Ana M. Bolaños-Portilla, Manish Dhawan, Alfonso J. Rodríguez-Morales, Kuldeep Dhama
    Journal of Experimental Biology and Agricultural Sciences.2021; 9(2): 108.     CrossRef
Prescription of Systemic Steroids for Acute Respiratory Infections in Korean Outpatient Settings: Overall Patterns and Effects of the Prescription Appropriateness Evaluation Policy
Taejae Kim, Young Kyung Do
J Prev Med Public Health. 2020;53(2):82-88.   Published online November 18, 2019
DOI: https://doi.org/10.3961/jpmph.19.090
  • 8,535 View
  • 143 Download
  • 5 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
The objective of this study was to identify individual and institutional factors associated with the prescription of systemic steroids in patients with acute respiratory infections and to investigate the role of a policy measure aimed to reduce inappropriate prescriptions. Methods: We used data from the National Health Insurance Service-National Sample Cohort from 2006 to 2015 and focused on episodes of acute respiratory infection. Descriptive analysis and multiple logistic regression analysis were performed to identify individual-level and institution-level factors associated with the prescription of systemic steroids. In addition, steroid prescription rates were compared with antibiotic prescription rates to assess their serial trends in relation to Health Insurance Review and Assessment Service (HIRA) Prescription Appropriateness Evaluation policy. Results: Among a total of 9 460 552 episodes of respiratory infection, the steroid prescription rate was 6.8%. Defined daily doses/1000 persons/d of steroid increased gradually until 2009, but rose sharply since 2010. The steroid prescription rate was higher among ear, nose and throat specialties (13.0%) than other specialties, and in hospitals (8.0%) than in tertiary hospitals (3.0%) and other types of institutions. Following a prolonged reduction in the steroid prescription rate, this rate increased since the HIRA Prescription Appropriateness Evaluation dropped steroids from its list of evaluation items in 2009. Such a trend reversal was not observed for the prescription rate of antibiotics, which continue to be on the HIRA Prescription Appropriateness Evaluation list. Conclusions: Specialty and type of institution are important correlates of steroid prescriptions in cases of acute respiratory infection. Steroid prescriptions can also be influenced by policy measures, such as the HIRA Prescription Appropriateness Evaluation policy.
Summary
Korean summary
이 연구에서는 요양급여 청구자료를 기준으로 급성 상기도 감염에서 스테로이드를 처방하는 경우와 관련하여 다음과 같은 특징을 확인하였다. 첫째, 환자 특성과 기관 특성을 모두 고려하였을 때 진료과목과 기관의 종별 구분에서 감기 스테로이드 처방률은 상당한 변이를 보였다. 둘째, 약제급여적정성평가 항목에서 스테로이드가 제외된 직후 처방률이 시계열적으로 상승하였으며, 이는 처방 행태에 정책 요인이 중요한 영향을 미칠 수 있음을 뜻한다.

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  • Measurement of Ambulatory Medication Errors in Children: A Scoping Review
    Lisa Rickey, Katherine Auger, Maria T. Britto, Isabelle Rodgers, Shayna Field, Alayna Odom, Madison Lehr, Alexandria Cronin, Kathleen E. Walsh
    Pediatrics.2023;[Epub]     CrossRef
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    Xiaoyi Li, Zhen Zeng, Xingying Fan, Wenju Wang, Xiaobo Luo, Junli Yang, Yue Chang
    Risk Management and Healthcare Policy.2023; Volume 16: 2849.     CrossRef
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    Ji Yoon Han, Eun Ae Yang, Jung-Woo Rhim, Seung Beom Han
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Has the Copayment Ceiling Improved Financial Protection in the Korean National Health Insurance System? Evidence From the 2009 Policy Change
Tae-Jin Lee, Chelim Cheong
J Prev Med Public Health. 2017;50(6):393-400.   Published online November 9, 2017
DOI: https://doi.org/10.3961/jpmph.17.151
  • 9,408 View
  • 165 Download
  • 5 Crossref
AbstractAbstract PDF
Objectives
To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups.
Methods
This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics.
Results
The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients.
Conclusions
The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.
Summary

Citations

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  • Network analysis of stroke systems of care in Korea
    Jihoon Kang, Hyunjoo Song, Seong Eun Kim, Jun Yup Kim, Hong-Kyun Park, Yong-Jin Cho, Kyung Bok Lee, Juneyoung Lee, Ji Sung Lee, Ah Rum Choi, Mi Yeon Kang, Philip B Gorelick, Hee-Joon Bae
    BMJ Neurology Open.2024; 6(1): e000578.     CrossRef
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    Sujin Kim, Soonman Kwon
    Social Science & Medicine.2023; 326: 115929.     CrossRef
  • Cancer care patterns in South Korea: Types of hospital where patients receive care and outcomes using national health insurance claims data
    Dong‐Woo Choi, Sun Jung Kim, Seungju Kim, Dong Wook Kim, Wonjeong Jeong, Kyu‐Tae Han
    Cancer Medicine.2023; 12(13): 14707.     CrossRef
  • Changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes in Beijing, China
    Zhenyu Shi, Ping He, Dawei Zhu, Feng Lu, Qingyue Meng
    BMC Health Services Research.2022;[Epub]     CrossRef
  • News media’s framing of health policy and its implications for government communication: A text mining analysis of news coverage on a policy to expand health insurance coverage in South Korea
    Wonkwang Jo, Myoungsoon You
    Health Policy.2019; 123(11): 1116.     CrossRef
Factors Affecting the Downward Mobility of Psychiatric Patients: A Korean Study of National Health Insurance Beneficiaries
Un-Na Kim, Yeon-Yong Kim, Jin-Seok Lee
J Prev Med Public Health. 2016;49(1):53-60.   Published online December 22, 2015
DOI: https://doi.org/10.3961/jpmph.15.052
  • 8,578 View
  • 104 Download
  • 10 Crossref
AbstractAbstract PDF
Objectives
The purpose of this study is to examine the magnitude of and the factors associated with the downward mobility of first-episode psychiatric patients.
Methods
This study used the claims data from the Korean Health Insurance Review and Assessment Service. The study population included 19 293 first-episode psychiatric inpatients diagnosed with alcohol use disorder (International Classification of Diseases, 10th revision [ICD-10] code F10), schizophrenia and related disorders (ICD-10 codes F20-F29), and mood disorders (ICD-10 codes F30-F33) in the first half of 2005. This study included only National Health Insurance beneficiaries in 2005. The dependent variable was the occurrence of downward mobility, which was defined as a health insurance status change from National Health Insurance to Medical Aid. Logistic regression analysis was used to assess factors associated with downward drift of first-episode psychiatric patients.
Results
About 10% of the study population who were National Health Insurance beneficiaries in 2005 became Medical Aid recipients in 2007. The logistic regression analysis showed that age, gender, primary diagnosis, type of hospital at first admission, regular use of outpatient clinic, and long-term hospitalization are significant predictors in determining downward drift in newly diagnosed psychiatric patients.
Conclusions
This research showed that the downward mobility of psychiatric patients is affected by long-term hospitalization and medical care utilization. The findings suggest that early intensive intervention might reduce long-term hospitalization and the downward mobility of psychiatric patients.
Summary

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    İsmail Şan, Hanife Gülhan Orhan Karsak, Eyüp İzci, Kübra Öncül
    Heliyon.2024; 10(8): e29135.     CrossRef
  • Gender differences among long-stay inpatients with schizophrenia in China: A cross-sectional study
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Special Article
Designing an Effective Pay-for-performance System in the Korean National Health Insurance
Hyoung-Sun Jeong
J Prev Med Public Health. 2012;45(3):127-136.   Published online May 31, 2012
DOI: https://doi.org/10.3961/jpmph.2012.45.3.127
  • 16,205 View
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AbstractAbstract PDF

The challenge facing the Korean National Health Insurance includes what to spend money on in order to elevate the 'value for money.' This article reviewed the changing issues associated with quality of care in the Korean health insurance system and envisioned a picture of an effective pay-for-performance (P4P) system in Korea taking into consideration quality of care and P4P systems in other countries. A review was made of existing systematic reviews and a recent Organization for Economic Cooperation and Development survey. An effective P4P in Korea was envisioned as containing three features: measures, basis for reward, and reward. The first priority is to develop proper measures for both efficiency and quality. For further improvement of quality indicators, an electronic system for patient history records should be built in the near future. A change in the level or the relative ranking seems more desirable than using absolute level alone for incentives. To stimulate medium- and small-scale hospitals to join the program in the next phase, it is suggested that the scope of application be expanded and the level of incentives adjusted. High-quality indicators of clinical care quality should be mapped out by combining information from medical claims and information from patient registries.

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    Kyunghee Yi, Sujin Kim
    Journal of Patient Experience.2023;[Epub]     CrossRef
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    Ye-Seul Lee, Song-Yi Kim, Younbyoung Chae, Kwasi Torpey
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    Hongsoo Kim, Shou-Hsia Cheng
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  • Impact of health insurance status changes on healthcare utilisation patterns: a longitudinal cohort study in South Korea
    Jae-Hyun Kim, Sang Gyu Lee, Kwang-Soo Lee, Sung-In Jang, Kyung-Hee Cho, Eun-Cheol Park
    BMJ Open.2016; 6(4): e009538.     CrossRef
  • Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries
    Ricarda Milstein, Jonas Schreyoegg
    Health Policy.2016; 120(10): 1125.     CrossRef
  • Incidence of Adult In-Hospital Cardiac Arrest Using National Representative Patient Sample in Korea
    Yuri Choi, In Ho Kwon, Jinwoo Jeong, Junyoung Chung, Younghoon Roh
    Healthcare Informatics Research.2016; 22(4): 277.     CrossRef
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Review
Prevention in the United States Affordable Care Act.
Charles M Preston, Miriam Alexander
J Prev Med Public Health. 2010;43(6):455-458.
DOI: https://doi.org/10.3961/jpmph.2010.43.6.455
  • 5,444 View
  • 123 Download
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AbstractAbstract PDF
The Affordable Care Act (ACA) was signed into law on March 23, 2010 and will fundamentally alter health care in the United States for years to come. The US is currently one of the only industrialized countries without universal health insurance. The new law expands existing public insurance for the poor. It also provides financial credits to low income individuals and some small businesses to purchase health insurance. By government estimates, the law will bring insurance to 30 million people. The law also provides for a significant new investment in prevention and wellness. It appropriates an unprecedented $15 billion in a prevention and public health fund, to be disbursed over 10 years, as well as creates a national prevention council to oversee the government's prevention efforts. This paper discusses 3 major prevention provisions in the legislation: 1) the waiving of cost-sharing for clinical preventive services, 2) new funding for community preventive services, and 3) new funding for workplace wellness programs. The paper examines the scientific evidence behind these provisions as well as provides examples of some model programs. Taken together, these provisions represent a significant advancement for prevention in the US health care system, including a shift towards healthier environments. However, in this turbulent economic and political environment, there is a real threat that much of the law, including the prevention provisions, will not receive adequate funding.
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English Abstracts
Impact of Health Insurance Type on the Quality of Hemodialysis Services: A Multilevel Analysis.
Jin Hee Jung, Soon Man Kwon, Kyoung Hoon Kim, Seon Kyoung Lee, Dong Sook Kim
J Prev Med Public Health. 2010;43(3):245-256.
DOI: https://doi.org/10.3961/jpmph.2010.43.3.245
  • 4,858 View
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  • 3 Crossref
AbstractAbstract PDF
OBJECTIVES
This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid. METHODS: This study used data from sampled hospitals that provided a hemodialysis service. A total of 2287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time, erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as: hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best). RESULTS: There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI=0.43-0.99). However, frequency of hemodialysis, hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb> or =11 g/dL, blood pressure within the range of 100-140/60-90 mmHg, calcium x phosphate< or =55 g2/dL2 and albumin> or =4 g/dL were not significantly different between the groups. CONCLUSIONS: There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis.
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  • A Study of Effect on the Smoking Status using Multilevel Logistic Model
    Ji Hye Lee, Tae-Young Heo
    Korean Journal of Applied Statistics.2014; 27(1): 89.     CrossRef
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    Young Eun Choi, Kang Suk Lee
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Strengthening Causal Inference in Studies using Non-experimental Data: An Application of Propensity Score and Instrumental Variable Methods.
Myoung Hee Kim, Young Kyung Do
J Prev Med Public Health. 2007;40(6):495-504.
DOI: https://doi.org/10.3961/jpmph.2007.40.6.495
  • 4,956 View
  • 86 Download
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AbstractAbstract PDF
OBJECTIVES
This study attempts to show how studies using non-experimental data can strengthen causal inferences by applying propensity score and instrumental variable methods based on the counterfactual framework. For illustrative purposes, we examine the effect of having private health insurance on the probability of experiencing at least one hospital admission in the previous year. METHODS: Using data from the 4th wave of the Korea Labor and Income Panel Study, we compared the results obtained using propensity score and instrumental variable methods with those from conventional logistic and linear regression models, respectively. RESULTS: While conventional multiple regression analyses fail to identify the effect, the results estimated using propensity score and instrumental variable methods suggest that having private health insurance has positive and statistically significant effects on hospital admission. CONCLUSIONS: This study demonstrates that propensity score and instrumental variable methods provide potentially useful alternatives to conventional regression approaches in making causal inferences using non-experimental data.
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    Boyoung Jeon, Soonman Kwon
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    Minsoo Jung
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Strategy Considerations in Genome Cohort Construction in Korea.
Joohon Sung, Sung Il Cho
J Prev Med Public Health. 2007;40(2):95-101.
DOI: https://doi.org/10.3961/jpmph.2007.40.2.95
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AbstractAbstract PDF
Focusing on complex diseases of public health significance, strategic issues regarding the on-going Korean Genome Cohort were reviewed: target size and diseases, measurements, study design issues, and followup strategy of the cohort. Considering the epidemiologic characteristics of Korean population as well as strengths and drawbacks of current research environment, we tried to tailor the experience of other existing cohorts into proposals for this Korean study. Currently 100,000 individuals have been participating the new Genome Cohort in Korea. Target size of de novo collection is recommended to be set as between 300,000 to 500,000. This target size would allow acceptable power to detect genetic and environmental factors of moderate effect size and possible interactions between them. Family units and/or special subgroups are recommended to parallel main body of adult individuals to increase the overall efficiency of the study. Given that response rate to the conventional re-contact method may not be satisfactory, successful follow-up is the main key to the achievement of the Korean Genome Cohort. Access to the central database such as National Health Insurance data can provide enormous potential for near-complete case detection. Efforts to build consensus amongst scientists from broad fields and stakeholders are crucial to unleash the centralized database as well as to refine the commitment of this national project.
Summary
Original Article
Assessment of the Availability of Health Insurance Data for Epidemiologic Study of Childhood Aseptic Meningitis.
Sue Kyung Park, Hae Kwan Cheong, Moran Ki, Young Mo Son, Ho Kim
Korean J Prev Med. 2003;36(4):349-358.
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AbstractAbstract PDF
OBJECTIVES
Aseptic meningitis is a major cause of Korean childhood morbidity late spring and early summer. However, the nationwide incidences of the disease have not been reported. This study was conducted to evaluate the availability of National Health Insurance data (NHID) for the study of an epidemiological trend in the surveillance of aseptic meningitis in children. METHODS: All the claims, under A87, A87.8, and A87.9 by ICD-10, among children below 15 years of age, to the National Health Insurance Corporation, between January and December 1998, were extracted. A survey of the medical record of 3, 874 cases from 136 general hospitals was performed. The availability of the NHID was evaluated by the three following methods: 1) The diagnostic accuracy (the positive predictive value = proportion of the confirmed aseptic meningitis among the subjects registered as above disease-codes in NHID) was evaluated through a chart review, and according to age, gender, month and region of disease-occurrence. 2) The distribution of confirmed cases was compared with the distribution of total subjects from the NHID, for subjects in General hospitals, or the subjects surveyed. 3) The proportion of confirmed CSF test was confirmed, and the relating factor, which was the difference in CSF-test rate, analyzed. RESULTS: Among 3, 874 cases, CSF examinations were performed on 1, 845 (47.6%), and the CSF-test rates were different according to the medical utility (admission vs. OPD visit) and the severity of the symptoms and signs. The diagnostic accuracy for aseptic meningitis, and during the epidemic (May-Aug) and sporadic (Sept-Apr) periods, were 85.0 (1, 568/1, 845), 86.0 (1, 239/1, 440) and 81.2% (329/405), respectively. The distributions by age, sex, month or period (epidemic/sporadic) and region, in the confirmed cases, were similar to those in the NHID, in both the subjects at General hospitals and in those surveyed, to within +/-7%. CONCLUSIONS: In this paper, the NHID for the subjects registered with an aseptic meningitis disease-code might be available for an epidemiological study on the incidence-estimation of childhood aseptic meningitis, as the NHID could include both the probable and definite cases. On the basis of this result, further studies of time-series and secular trend analyses, using the NHID, will be performed.
Summary

JPMPH : Journal of Preventive Medicine and Public Health