Journal of Preventive Medicine and Public Health

Perspective

Towards Mental Health Equity: Task Shifting Strategy to Overcome Barriers in Primary Healthcare Services in India: Suganya Panneerselvam, Senthilkumar Ramasamy, Sanjana Agrawal; J Prev Med Public Health. 2025;58(5):548-551. Published online June 13, 2025; DOI: https://doi.org/10.3961/jpmph.25.144

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Abstract Summary PDF: Mental illness remains among the top 10 causes of the global burden of disease. According to the National Mental Health Survey of India, 10.6% of adults exhibit mental disorders. India ideally requires 3 psychiatrists per 100 000 population, yet the current ratio is only 0.7 per 100 000. The country thus faces an urgent need to strengthen mental health infrastructure and expand training programs. Vulnerable groups—particularly residents of rural and remote areas, women, and older adults—are disproportionately affected by this situation. Individuals with mental illness often suffer in silence, enduring human rights violations, stigma, and discrimination. India’s National Mental Health Programme seeks to ensure the availability and accessibility of minimum mental health care for all, with a focus on the most vulnerable and underserved populations. The World Health Organization recommends task shifting or task sharing to improve access and deliver healthcare services in remote areas. Community Health Officers (CHOs) and Accredited Social Health Activists use community-based assessment checklists to identify individuals at risk of communicable, non-communicable, and mental health disorders. CHOs then ensure continuity of care through regular follow-up, bridging the gap between diagnosis and ongoing treatment. This practice significantly augments the effectiveness of community-level mental health interventions. Integrating mental health into primary health care should facilitate earlier detection and treatment of mental health disorders.; Summary

Key Message
Mental illness remains among the top 10 causes of the global burden of disease. Stigma associated with these disorders exacerbates the problem, leading to social discrimination. The Ayushman Bharat initiative is a transformative step towards strengthening India’s healthcare system. CHOs and ASHAs use community-based assessment checklists to identify individuals at risk of communicable, non-communicable, and mental health disorders within their communities. This task-shifting approach empowers local communities and fosters participation, reducing disease burden and offering a sustainable, effective model.

Original Articles

Prognostic Scoring Model for the Transition From Acute to Chronic Non-specific Low Back Pain in Primary Health Care Units in Indonesia: Djoko Kuswanto, Riva Satya Radiansyah, Dwinka Syafira Eljatin, Muhammad Nazhif Haykal, Rumman Karimah, Ratri Dwi Indriani, Zain Budi Syulthoni, Erna Furaidah, Andiva Satrio Rinaldi, Hafira Nushifa Putri, Jessica Felina Adi, Anak Agung Bagus Wirayuda; J Prev Med Public Health. 2025;58(4):422-430. Published online April 12, 2025; DOI: https://doi.org/10.3961/jpmph.24.581

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Abstract Summary PDF Supplementary Material

Objectives
Non-specific low back pain (NSLBP) is a prevalent health issue that can progress from acute to chronic, resulting in prolonged disability and diminished quality of life. This study aimed to develop a prognostic scoring model to predict the transition from acute to chronic NSLBP in primary care settings.
Methods
This prospective cohort study enrolled 112 adults with acute NSLBP from primary health care units in Indonesia. Participants were assessed at baseline and at a 3-month follow-up visit. Bivariate and multivariable analyses were conducted to identify significant predictors of chronicity. A scoring system was then developed based on the final logistic regression model.
Results
Three factors were found to be significant predictors of the transition to chronic NSLBP: age above 30 years, low education level, and moderate to severe pain intensity. The prognostic scoring model demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.705, 70.8% sensitivity, and 62.5% specificity at the optimal cut-off score of 2.5.
Conclusions
This simple prognostic scoring model can help clinicians identify patients at high-risk of developing chronic NSLBP. Early identification of at-risk patients could guide targeted interventions to prevent chronicity. Further validation in diverse populations is necessary to confirm the broader applicability of this model.

Summary

Key Message
This prospective cohort study developed a prognostic scoring model to predict the transition from acute to chronic non-specific low back pain (NSLBP) in primary care settings in Indonesia. The study identified three significant predictors: age above 30 years, low education level, and moderate to severe pain intensity, which formed a simple scoring system with good discrimination ability (AUC = 0.705, sensitivity 70.8%, specificity 62.5%). This practical tool enables clinicians to identify high-risk patients early and implement targeted interventions to prevent chronicity in primary healthcare settings.

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The Role of Dexketoprofen/Tramadol in Multimodal Therapy to Prevent Acute Postsurgical and Acute Low Back Pain from Developing into Chronic Pain: A Delphi Consensus Study
Giustino Varrassi, Maria Dolma Gudez-Santos, Magdi Hanna, Magdalena Kocot-Kępska, Antonio Montero Matamala, Marco Antonio Narvaez Tamayo, Serge Perrot, Jose Luis Aguilar, Omar Al Hamad, Lu’i Al-Husinat, Raad Al-Khafaji, Abdallah Allam, Ezio Amorizzo, Nadi
Pain and Therapy.2026; 15(1): 175. CrossRef

The Impact of COVID-19 on Healthcare Services in Bangladesh: A Qualitative Study on Healthcare Providers’ Perspectives: Sharmin Parveen, Md. Shahriar Mahbub, Nasreen Nahar, K. A. M. Morshed, Nourin Rahman, Ezzat Tanzila Evana, Nazia Islam, Abu Said Md. Juel Miah; J Prev Med Public Health. 2024;57(4):356-369. Published online June 9, 2024; DOI: https://doi.org/10.3961/jpmph.24.081

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Abstract Summary PDF

Objectives
The objective of this study was to explore healthcare providers’ experiences in managing the coronavirus disease 2019 (COVID-19) pandemic and its impact on healthcare services.
Methods
A qualitative study was conducted with 34 healthcare professionals across 15 districts in Bangladesh. Among the participants, 24 were health managers or administrators stationed at the district or upazila (sub-district) level, and 10 were clinicians providing care to patients with COVID-19. The telephone interviews were conducted in Bangla, audio-recorded, transcribed, and then translated into English. Data were analyzed thematically.
Results
Most interviewees identified a range of issues within the health system. These included unpreparedness, challenges in segregating COVID-19 patients, maintaining isolation and home quarantine, a scarcity of intensive care unit beds, and ensuring continuity of service for non-COVID-19 patients. The limited availability of personal protective equipment, a shortage of human resources, and logistical challenges, such as obtaining COVID-19 tests, were frequently cited as barriers to managing the pandemic. Additionally, changes in the behavior of health service seekers, particularly increased aggression, were reported. The primary motivating factor for healthcare providers was the willingness to continue providing health services, rather than financial incentives.
Conclusions
The COVID-19 pandemic presented a unique set of challenges for health systems, while also providing valuable lessons in managing a public health crisis. To effectively address future health crises, it is crucial to resolve a myriad of issues within the health system, including the inequitable distribution of human resources and logistical challenges.

Summary

Key Message
This qualitative study explored healthcare providers' perspectives on the impact of the COVID-19 pandemic on healthcare services. Issues within the health system, such as a lack of skilled human resources, insufficient critical care facilities, low coverage of COVID-19 tests, inadequate logistical support, poor health behaviors and practices among health service seekers posed barriers to managing the pandemic at different healthcare levels. Ensuring personal protection for health professionals in the face of a novel disease presented a significant challenge. Increasing resource allocation and developing the capacity of healthcare providers were identified as potential solutions.

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The Female Sex Workers' Experiences of Accessing Healthcare Services in Bangladesh: A Qualitative Investigation
Shaharior Rahman Razu, Kim Usher, Rikki Jones, Md. Shahidul Islam
Diversity & Inclusion Research.2025;[Epub] CrossRef
Impacts of Covid-19 on the Treatment of Kidney Dialysis Patients in Bangladesh: Lessons Learned and Future Directions

European Journal of Medical and Health Sciences.2025; : 533. CrossRef
Specific Trends in Blood Utilization During the COVID-19 Pandemic: A Retrospective Analysis of a Hungarian Clinical Centre
Sándor Pál, Margit Solymár, Barbara Réger, Hussain Alizadeh, András Vereczkei, Tamás Kiss, Zsuzsanna Faust
Journal of Clinical Medicine.2025; 14(22): 7943. CrossRef

Healthcare Systems and COVID-19 Mortality in Selected OECD Countries: A Panel Quantile Regression Analysis: Jalil Safaei, Andisheh Saliminezhad; J Prev Med Public Health. 2023;56(6):515-522. Published online October 15, 2023; DOI: https://doi.org/10.3961/jpmph.23.162

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Abstract Summary PDF

Objectives
The pandemic caused by coronavirus disease 2019 (COVID-19) has exerted an unprecedented impact on the health of populations worldwide. However, the adverse health consequences of the pandemic in terms of infection and mortality rates have varied across countries. In this study, we investigate whether COVID-19 mortality rates across a group of developed nations are associated with characteristics of their healthcare systems, beyond the differential policy responses in those countries.
Methods
To achieve the study objective, we distinguished healthcare systems based on the extent of healthcare decommodification. Using available daily data from 2020, 2021, and 2022, we applied quantile regression with non-additive fixed effects to estimate mortality rates across quantiles. Our analysis began prior to vaccine development (in 2020) and continued after the vaccines were introduced (throughout 2021 and part of 2022).
Results
The findings indicate that higher testing rates, coupled with more stringent containment and public health measures, had a significant negative impact on the death rate in both pre-vaccination and post-vaccination models. The data from the post-vaccination model demonstrate that higher vaccination rates were associated with significant decreases in fatalities. Additionally, our research indicates that countries with healthcare systems characterized by high and medium levels of decommodification experienced lower mortality rates than those with healthcare systems involving low decommodification.
Conclusions
The results of this study indicate that stronger public health infrastructure and more inclusive social protections have mitigated the severity of the pandemic’s adverse health impacts, more so than emergency containment measures and social restrictions.

Summary

Key Message
This study investigates whether COVID-19 mortality rates across a group of developed nations are associated with characteristics of their healthcare systems, beyond the differential policy responses in those countries. To this aim, a quantile regression with non-additive fixed effects is applied to estimate mortality rates across quantiles. The results of this study indicate that stronger public health infrastructure and more inclusive social protections have mitigated the severity of the pandemic’s adverse health impacts, more so than emergency containment measures and social restrictions.

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Ahmet Kasap
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Clinical Associations with Hospital Escalation Among COVID-19 Patients Receiving Remdesivir in a Hospital-at-Home Service: A Real-World Cohort Study
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Journal of Clinical Medicine.2025; 14(19): 6736. CrossRef

Changes in the Hospital Standardized Mortality Ratio Before and During the COVID-19 Pandemic: A Disaggregated Analysis by Region and Hospital Type in Korea: EunKyo Kang, Won Mo Jang, Min Sun Shin, Hyejin Lee, Jin Yong Lee; J Prev Med Public Health. 2023;56(2):180-189. Published online March 20, 2023; DOI: https://doi.org/10.3961/jpmph.22.479

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Abstract Summary PDF

Objectives
The coronavirus disease 2019 (COVID-19) pandemic has led to a global shortage of medical resources; therefore, we investigated whether COVID-19 impacted the quality of non-COVID-19 hospital care in Korea by comparing hospital standardized mortality rates (HSMRs) before and during the pandemic.
Methods
This retrospective cohort study analyzed Korean National Health Insurance discharge claim data obtained from January to June in 2017, 2018, 2019, and 2020. Patients’ in-hospital deaths were classified according to the most responsible diagnosis categories. The HSMR is calculated as the ratio of expected deaths to actual deaths. The time trend in the overall HSMR was analyzed by region and hospital type.
Results
The final analysis included 2 252 824 patients. In 2020, the HSMR increased nationwide (HSMR, 99.3; 95% confidence interval [CI], 97.7 to 101.0) in comparison to 2019 (HSMR, 97.3; 95% CI, 95.8 to 98.8). In the COVID-19 pandemic zone, the HSMR increased significantly in 2020 (HSMR, 112.7; 95% CI, 107.0 to 118.7) compared to 2019 (HSMR, 101.7; 95% CI, 96.9 to 106.6). The HSMR in all general hospitals increased significantly in 2020 (HSMR, 106.4; 95% CI, 104.3 to 108.5) compared to 2019 (HSMR, 100.3; 95% CI, 98.4 to 102.2). Hospitals participating in the COVID-19 response had a lower HSMR (HSMR, 95.6; 95% CI, 93.9 to 97.4) than hospitals not participating in the COVID-19 response (HSMR, 124.3; 95% CI, 119.3 to 129.4).
Conclusions
This study suggests that the COVID-19 pandemic may have negatively impacted the quality of care in hospitals, especially general hospitals with relatively few beds. In light of the COVID-19 pandemic, it is necessary to prevent excessive workloads in hospitals and to properly employ and coordinate the workforce.

Summary

Korean summary
코로나19 대유행 지역은 비감염 지역과 달리 2019년에 비해 2020년에 HSMR이 크게 증가했고, 상대적으로 병상 수가 적은 종합병원에서 HSMR이 증가했다. 코로나19 대응에 참여하는 병원은 병원 규모와 관계없이 HSMR이 낮은 경향을 보였다. 감염병 유행 시 병원의 과도한 업무량이 부여되지 않게하고 인력을 적절하게 고용하여 조정하는 것이 필요하다.

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Youngs Chang, Soo-Hee Hwang, Haibin Bai, Seowoo Park, Eunbyul Cho, Dohoung Kim, Hyejin Lee, Jin Yong Lee
Journal of Preventive Medicine and Public Health.2025; 58(1): 60. CrossRef
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PLOS ONE.2025; 20(2): e0316943. CrossRef
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Systematic Review

Factors Associated With Failure of Health System Reform: A Systematic Review and Meta-synthesis: Mahboubeh Bayat, Tahereh Kashkalani, Mahmoud Khodadost, Azad Shokri, Hamed Fattahi, Faeze Ghasemi Seproo, Fatemeh Younesi, Roghayeh khalilnezhad; J Prev Med Public Health. 2023;56(2):128-144. Published online March 14, 2023; DOI: https://doi.org/10.3961/jpmph.22.394

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Abstract PDF

Objectives
The health system reform process is highly political and controversial, and in most cases, it fails to realize its intended goals. This study was conducted to synthesize factors underlying the failure of health system reforms.
Methods
In this systematic review and meta-synthesis, we searched 9 international and regional databases to identify qualitative and mixed-methods studies published up to December 2019. Using thematic synthesis, we analyzed the data. We utilized the Standards for Reporting Qualitative Research checklist for quality assessment.
Results
After application of the inclusion and exclusion criteria, 40 of 1837 articles were included in the content analysis. The identified factors were organized into 7 main themes and 32 sub-themes. The main themes included: (1) reforms initiators’ attitudes and knowledge; (2) weakness of political support; (3) lack of interest group support; (4) insufficient comprehensiveness of the reform; (5) problems related to the implementation of the reform; (6) harmful consequences of reform implementation; and (7) the political, economic, cultural, and social conditions of the society in which the reform takes place.
Conclusions
Health system reform is a deep and extensive process, and shortcomings and weaknesses in each step have overcome health reform attempts in many countries. Awareness of these failure factors and appropriate responses to these issues can help policymakers properly plan and implement future reform programs and achieve the ultimate goals of reform: to improve the quantity and quality of health services and the health of society.

Summary

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Original Articles

SWOT Analysis and Expert Assessment of the Effectiveness of the Introduction of Healthcare Information Systems in Polyclinics in Aktobe, Kazakhstan: Lyudmila Yermukhanova, Zhanar Buribayeva, Indira Abdikadirova, Anar Tursynbekova, Meruyert Kurganbekova; J Prev Med Public Health. 2022;55(6):539-548. Published online October 11, 2022; DOI: https://doi.org/10.3961/jpmph.22.360

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Abstract PDF

Objectives
The purpose of this study was to assess the organizational effectiveness of the introduction of a healthcare information system (electronic medical records and databases) in healthcare in Kazakhstan.
Methods
The authors used a combination of 2 methods: expert assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis. SWOT analysis is a necessary element of research, constituting a mandatory preliminary stage both when drawing up strategic plans and for taking corrective measures in the future. The expert survey was conducted using 2 questionnaires.
Results
The study involved 40 experts drawn from specialists in primary healthcare in Aktobe: 15 representatives of administrative and managerial personnel (chief doctors and their deputies, heads of medical statistics offices, organizational and methodological offices, and internal audit services) and 25 general practitioners.
Conclusions
The following functional indicators of the medical and organizational effectiveness of the introduction of information systems in polyclinics were highlighted: first, improvement of administrative control, followed in descending order by registration and movement of medical documentation, statistical reporting and process results, and the cost of employees’ working time. There has been no reduction in financial costs, namely in terms of the costs of copying, delivery of information in paper form, technical equipment, and paper.

Summary

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Increase in Potential Low-value Magnetic Resonance Imaging Utilization Due to Out-of-pocket Payment Reduction Across Income Groups in Korea: An Experimental Vignette Study: Yukyung Shin, Ji-su Lee, Young Kyung Do; J Prev Med Public Health. 2022;55(4):389-397. Published online July 11, 2022; DOI: https://doi.org/10.3961/jpmph.22.208

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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.

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Public Preferences for Allocation Principles for Scarce Medical Resources in the COVID-19 Pandemic in Korea: Comparisons With Ethicists’ Recommendations: Ji-Su Lee, Soyun Kim, Young Kyung Do; J Prev Med Public Health. 2021;54(5):360-369. Published online August 26, 2021; DOI: https://doi.org/10.3961/jpmph.21.333

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Abstract Summary PDF Supplementary Material

Objectives
The purpose of this study was to investigate public preferences regarding allocation principles for scarce medical resources in the coronavirus disease 2019 (COVID-19) pandemic, particularly in comparison with the recommendations of ethicists.
Methods
An online survey was conducted with a nationally representative sample of 1509 adults residing in Korea, from November 2 to 5, 2020. The degree of agreement with resource allocation principles in the context of the medical resource constraints precipitated by the COVID-19 pandemic was examined. The results were then compared with ethicists’ recommendations. We also examined whether the perceived severity of COVID-19 explained differences in individual preferences, and by doing so, whether perceived severity helps explain discrepancies between public preferences and ethicists’ recommendations.
Results
Overall, the public of Korea agreed strongly with the principles of “save the most lives,” “Koreans first,” and “sickest first,” but less with “random selection,” in contrast to the recommendations of ethicists. “Save the most lives” was given the highest priority by both the public and ethicists. Higher perceived severity of the pandemic was associated with a greater likelihood of agreeing with allocation principles based on utilitarianism, as well as those promoting and rewarding social usefulness, in line with the opinions of expert ethicists.
Conclusions
The general public of Korea preferred rationing scarce medical resources in the COVID-19 pandemic predominantly based on utilitarianism, identity and prioritarianism, rather than egalitarianism. Further research is needed to explore the reasons for discrepancies between public preferences and ethicists’ recommendations.

Summary

Korean summary
코로나19 대유행으로 가시화된 의료자원의 부족 상황에서 서로 다른 의료자원 배분 원칙에 대한 일반 대중의 선호를 조사한 연구이다. 제시된 여러 원칙 중에서, 공리주의, 한국인 아이덴티티, 약자우선주의에 기초한 배분 원칙이 가장 높은 선호를 보였다. 이러한 결과는, 일반 상황과 달리 감염병 대유행 상황에서는 공리주의에 기초한 배분 원칙을 강화하되 사회적 유용성도 자원 배분의 주요 원칙으로 받아들일 수 있다는 윤리학자들의 견해와는 차이를 보인다.

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Perspective

What Else Is Needed in the Korean Government’s Master Plan for People With Developmental Disabilities?: Jin Yong Lee, Jieun Yun; J Prev Med Public Health. 2019;52(3):200-204. Published online May 7, 2019; DOI: https://doi.org/10.3961/jpmph.18.249

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On September 12, 2018, President Jae-In Moon announced the Comprehensive Plan for Lifelong Care for People with Developmental Disabilities, with representatives from the associated government branches (Ministry of Health and Welfare, Ministry of Education, and Ministry of Employment and Labor) in attendance. The goals of this plan are to provide health, medical, rehabilitative, special education, and social welfare services according to the life-stages of the affected individuals; to reduce parental pressure; to promote social interventions; and to enhance community-level participation in order to create a ‘welfare society in harmony.’ However, in order for the plan to succeed, additional efforts must be made in the following areas. First, an epidemiological survey is needed to understand the scale, prevalence, and incidence of developmental disabilities and to establish an evidence base to support policy development. Second, accurate definitions of developmental disabilities must be established in order to avoid policy discrimination based on impairment type and age. Third, personal evaluations to assess disabled individuals’ unmet needs and customized service designs to deliver those needs are required. Fourth, the plan must fulfill the goals of accessibility and fairness that the government intends to provide. Fifth, the government should consider an integrated financial support system and to propose a detailed plan for monetary distributions. Finally, an integrated system that links health, medical, employment, educational, and welfare services must be constructed.

Summary

Korean summary
2018년 9월 대통령이 직접 발표한 “발달장애인 평생케어 종합대책”의 성공적인 수행을 위해 필수적인 정책을 제안하였다. 특히, 발달장애인의 정확한 규모, 유병률, 발생률 등 기초적인 현황 파악과 정책 개발을 뒷받침하기 위한 역학연구, 발달장애인 개인평가에 기반한 미충족 필요의 측정과 이를 바탕으로 한 개인별 맟춤형 서비스 디자인, 서비스의 접근성과 형평성 달성, 그리고 보건-의료-고용-교육-복지서비스를 통합적으로 제공할 수 있는 시스템 구축이 필요함을 지적하였다.

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Original Articles

Impact of Regional Cardiocerebrovascular Centers on Myocardial Infarction Patients in Korea: A Fixed-effects Model: Sang Guen Cho, Youngsoo Kim, Youngeun Choi, Wankyo Chung; J Prev Med Public Health. 2019;52(1):21-29. Published online November 28, 2018; DOI: https://doi.org/10.3961/jpmph.18.154

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Objectives
The Regional Cardiocerebrovascular Center (RCCVC) Project designated local teaching hospitals as RCCVCs, in order to improve patient outcomes of acute cardiocerebrovascular emergencies by founding a regional system that can adequately transfer and manage patients within 3 hours. We investigated the effects of RCCVC establishment on treatment volume and 30-day mortality.
Methods
We constructed a panel dataset by extracting all acute myocardial infarction cases that occurred from 2007 to 2016 from the Health Insurance Review and Assessment Service claims data, a national and representative source. We then used a panel fixed-effect model to estimate the impacts of RCCVC establishment on patient outcomes.
Results
We found that the number of cases of acute myocardial infarction that were treated increased chronologically, but when the time effect and other related covariates were controlled for, RCCVCs only significantly increased the number of treatment cases of female in large catchment areas. There was no statistically significant impact on 30-day mortality.
Conclusions
The establishment of RCCVCs increased the number of treatment cases of female, without increasing the mortality rate. Therefore, the RCCVCs might have prevented potential untreated deaths by increasing the preparedness and capacity of hospitals to treat acute myocardial infarction patients.

Summary

Korean summary
권역심뇌혈관질환센터 설립 사업은 지역별로 심뇌혈관센터를 지정/육성하여, 심뇌혈관질환 발생시 3시간 이내 진료체계를 구축함으로써 급성심근경색과 뇌졸중의 급성기 응급상황에 대한 대응을 강화하고자 시행되었다. 본 연구는 권역심뇌혈관질환센터 설립 정책으로 인해 시술 건수와 30일 내 사망 등과 같은 치료 성과가 지역 수준에서 향상되었는지 살펴보기 위해 건강보험 청구자료로 지역 수준 패널자료를 구축하여 권역심뇌혈관질환센터 설립의 효과를 추정하였다. 분석 결과, 시계열적 효과와 관련 변수를 통제하였을 때 권역심뇌혈관질환센터 설립 이후 설립 지역에서 여성의 치료 사례 수가 통계적으로 유의하게 증가하였고, 사망률은 유의미한 변화가 관찰되지 않았다. 따라서 권역심뇌혈관질환센터 설립은 대비성 향상과 치료 사례 수 증가를 통해 추가적인 치료를 받은 급성심근경색 환자의 잠재적인 원외 사망을 방지하는 효과가 있는 것으로 판단된다.

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Knowledge, Perceptions, and Self-reported Performance of Hand Hygiene Among Registered Nurses at Community-based Hospitals in the Republic of Korea: A Cross-sectional Multi-center Study: Hyang Soon Oh; J Prev Med Public Health. 2018;51(3):121-129. Published online May 14, 2018; DOI: https://doi.org/10.3961/jpmph.17.188

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Objectives
To assess the nurses’ hand hygiene (HH) knowledge, perception, attitude, and self-reported performance in small- and medium-sized hospitals after Middle East Respiratory Syndrome outbreak.
Methods
The structured questionnaire was adapted from the World Health Organization’s survey. Data were collected between June 26 and July 14, 2017.
Results
Nurses showed scores on knowledge (17.6±2.5), perception (69.3±0.8), self-reported HH performance of non-self (86.0±11.0), self-reported performance of self (88.2±11.0), and attitude (50.5±5.5). HH performance rate of non-self was Y₁=36.678+ 0.555X₁ (HH performance rate of self) (adjusted R²=0.280, p<0.001). The regression model for performance was Y₄=18.302+0.247X₄₁ (peception)+0.232X₄₂ (attitude)+0.875X₄₂ (role model); coefficients were significant statistically except attitude, and this model significant statistically (adjusted R²=0.191, p<0.001).
Conclusions
Advanced HH education program would be developed and operated continuously. Perception, attitude, role model was found to be a significant predictors of HH performance of self. So these findings could be used in future HH promotion strategies for nurses.

Summary

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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

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Abstract 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

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Special Article

Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea: Jong-Myon Bae; J Prev Med Public Health. 2017;50(4):217-227. Published online June 16, 2017; DOI: https://doi.org/10.3961/jpmph.17.069

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In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.

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Original Articles

Evaluation of Geographic Indices Describing Health Care Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Yoon Kim; J Prev Med Public Health. 2017;50(1):29-37. Published online December 19, 2016; DOI: https://doi.org/10.3961/jpmph.16.099

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Abstract PDF

Objectives
The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization.
Methods
We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates.
Results
In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index.
Conclusions
Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

Summary

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Factors Associated with End-Of-Life Health Care Use and Spending in Korea in Comparison with the General Population
Agnus M. Kim, Yoon Kim
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Timothy A. Reistetter, Julianna M. Dean, Allen M. Haas, John D. Prochaska, Daniel C. Jupiter, Karl Eschbach, Yong-Fang Kuo
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Presence of Thrombectomy-capable Stroke Centers Within Hospital Service Areas Explains Regional Variation in the Case Fatality Rate of Acute Ischemic Stroke in Korea
Eun Hye Park, Yong Jin Gil, Chanki Kim, Beom Joon Kim, Seung-sik Hwang
Journal of Preventive Medicine and Public Health.2021; 54(6): 385. CrossRef
An ecological study of geographic variation and factors associated with cesarean section rates in South Korea
Agnus M. Kim, Jong Heon Park, Sungchan Kang, Tae Ho Yoon, Yoon Kim
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The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Kyosang Hwang, Taesik Lee, Yoon Kim; J Prev Med Public Health. 2016;49(4):230-239. Published online July 14, 2016; DOI: https://doi.org/10.3961/jpmph.16.034

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Objectives
We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts) and new areal units organized based on the actual health care use of the population in Korea.
Methods
To compare geographic variation in geographic units of analysis, we calculated the age–sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan) from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units.
Results
Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures.
Conclusions
Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.

Summary

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Determinants of Mental Health Care Utilization in a Suicide High-risk Group With Suicidal Ideation: Hyun-Soo Kim, Moo-Sik Lee, Jee-Young Hong; J Prev Med Public Health. 2016;49(1):69-78. Published online January 22, 2016; DOI: https://doi.org/10.3961/jpmph.15.016

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Objectives
The suicide rate in Korea is increasing every year, and is the highest among the Organization for Economic Cooperation and Development countries. Psychiatric patients in particular have a higher risk of suicide than other patients. This study was performed to evaluate determinants of mental health care utilization among individuals at high risk for suicide.
Methods
Korea Health Panel data from 2009 to 2011 were used. Subjects were individuals at high risk of suicide who had suicidal ideation, a past history of psychiatric illness, or had utilized outpatient services for a psychiatric disorder associated with suicidal ideation within the past year. The chi-square test and hierarchical logistic regression were used to identify significant determinants of mental health care utilization.
Results
The total number of subjects with complete data on the variables in our model was 989. Individuals suffering from three or more chronic diseases used mental health care more frequently. Mental health care utilization was higher in subjects who had middle or high levels of educational attainment, were receiving Medical Aid, or had a large family size.
Conclusions
It is important to control risk factors in high-risk groups as part of suicide prevention strategies. The clinical approach, which includes community-based intervention, entails the management of reduction of suicidal risk. Our study identified demographic characteristics that have a significant impact on mental health care utilization and should be considered in the development of suicide prevention strategies. Further studies should examine the effect of mental health care utilization on reducing suicidal ideation.

Summary

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Perspective

Implementation of Quaternary Prevention in the Korean Healthcare System: Lessons From the 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea: Jong-Myon Bae; J Prev Med Public Health. 2015;48(6):271-273. Published online November 24, 2015; DOI: https://doi.org/10.3961/jpmph.15.059

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Quaternary prevention should be implemented to minimize harm to patients because the ultimate goal of medicine is to prevent disease and promote health. Primary care physicians have a major responsibility in quaternary prevention, and the establishment of clinical epidemiology as a distinct field of study would create a role charged with minimizing patient harm arising from over-medicalization.

Summary

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Original Articles

Prevalence of Depressive Disorder of Outpatients Visiting Two Primary Care Settings: Sun-Jin Jo, Hyeon Woo Yim, Hyunsuk Jeong, Hoo Rim Song, Sang Yhun Ju, Jong Lyul Kim, Tae-Youn Jun; J Prev Med Public Health. 2015;48(5):257-263. Published online September 21, 2015; DOI: https://doi.org/10.3961/jpmph.15.009

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Objectives
Although the prevalence of depressive disorders in South Korea’s general population is known, no reports on the prevalence of depression among patients who visit primary care facilities have been published. This preliminary study was conducted to identify the prevalence of depressive disorder in patients that visit two primary care facilities.
Methods
Among 231 consecutive eligible patients who visited two primary care settings, 184 patients consented to a diagnostic interview for depression by psychiatrists following the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. There were no significant differences in sociodemographic characteristics such as gender, age, or level of education between the groups that consented and declined the diagnostic examination. The prevalence of depressive disorder and the proportion of newly diagnosed patients among depressive disorder patients were calculated.
Results
The prevalence of depressive disorder of patients in the two primary care facilities was 14.1% (95% confidence interval [CI], 9.1 to 19.2), with major depressive disorder 5.4% (95% CI, 2.1 to 8.7), dysthymia 1.1% (95% CI, 0.0 to 2.6), and depressive disorder, not otherwise specified 7.6% (95% CI, 3.7 to 11.5). Among the 26 patients with depressive disorder, 19 patients were newly diagnosed.
Conclusions
As compared to the general population, a higher prevalence of depressive disorders was observed among patients at two primary care facilities. Further study is needed with larger samples to inform the development of a primary care setting-based depression screening, management, and referral system to increase the efficiency of limited health care resources.

Summary

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Soroush Bijani, Fatemeh Sadat Kashfi, Sadaf Zahedi-Vanjani, Keivan Nedaei, Ali Sharafi, Ali Kalantari-Hesari, Mir-Jamal Hosseini
Heliyon.2024; 10(7): e28964. CrossRef
Depression rates and health-seeking behavior in primary care: Andersen model of health- care utilization
Lana Alhalaseh, Karim Alsawalha, Mohammed Qussay Al-Sabbagh, Farah Al-Khaleefa
Psychology, Health & Medicine.2023; 28(6): 1503. CrossRef
Prevalence of depressive disorders in a primary care setting in Ho Chi Minh City, Vietnam: A cross-sectional epidemiological study
Ho Nguyen Yen Phi, Truong Quoc Tho, Bui Xuan Manh, Tran Anh Ngoc, Pham Thi Minh Chau, Nguyen Trung Nghia, Tran Trung Nghia, Huynh Ho Ngoc Quynh, Nguyen Tien Huy, Ngo Tich Linh, Pham Lê An
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Associations Between the Continuity of Ambulatory Care of Adult Diabetes Patients in Korea and the Incidence of Macrovascular Complications: Young-Hoon Gong, Seok-Jun Yoon, Hyeyoung Seo, Dongwoo Kim; J Prev Med Public Health. 2015;48(4):188-194. Published online July 23, 2015; DOI: https://doi.org/10.3961/jpmph.15.020

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Objectives
The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea.
Methods
This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited.
Results
Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance.
Conclusions
Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.

Summary

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Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea
Sanghyun Cho, Ji-Yeon Shin, Hyun Joo Kim, Sang Jun Eun, Sungchan Kang, Won Mo Jang, Hyemin Jung, Yoon Kim, Jin Yong Lee
Journal of Korean Medical Science.2019;[Epub] CrossRef

Variations in the Hospital Standardized Mortality Ratios in Korea: Eun-Jung Lee, Soo-Hee Hwang, Jung-A Lee, Yoon Kim; J Prev Med Public Health. 2014;47(4):206-215. Published online July 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.4.206

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Objectives
The hospital standardized mortality ratio (HSMR) has been widely used because it allows for robust risk adjustment using administrative data and is important for improving the quality of patient care.
Methods
All inpatients discharged from hospitals with more than 700 beds (66 hospitals) in 2008 were eligible for inclusion. Using the claims data, 29 most responsible diagnosis (MRDx), accounting for 80% of all inpatient deaths among these hospitals, were identified, and inpatients with those MRDx were selected. The final study population included 703 571 inpatients including 27 718 (3.9% of all inpatients) in-hospital deaths. Using logistic regression, risk-adjusted models for predicting in-hospital mortality were created for each MRDx. The HSMR of individual hospitals was calculated for each MRDx using the model coefficients. The models included age, gender, income level, urgency of admission, diagnosis codes, disease-specific risk factors, and comorbidities. The Elixhauser comorbidity index was used to adjust for comorbidities.
Results
For 26 out of 29 MRDx, the c-statistics of these mortality prediction models were higher than 0.8 indicating excellent discriminative power. The HSMR greatly varied across hospitals and disease groups. The academic status of the hospital was the only factor significantly associated with the HSMR.
Conclusions
We found a large variation in HSMR among hospitals; therefore, efforts to reduce these variations including continuous monitoring and regular disclosure of the HSMR are required.

Summary

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Development and Application of New Risk-Adjustment Models to Improve the Current Model for Hospital Standardized Mortality Ratio in South Korea
Hyeki Park, Ji-Sook Choi, Min Sun Shin, Soomin Kim, Hyekyoung Kim, Nahyeong Im, Soon Joo Park, Donggyo Shin, Youngmi Song, Yunjung Cho, Hyunmi Joo, Hyeryeon Hong, Yong-Hwa Hwang, Choon-Seon Park
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Functional training and timed nutrition intervention in infectious medical patients
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Determinants of Health Care Expenditures and the Contribution of Associated Factors: 16 Cities and Provinces in Korea, 2003-2010: Kimyoung Han, Minho Cho, Kihong Chun; J Prev Med Public Health. 2013;46(6):300-308. Published online November 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.6.300

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Abstract PDF

Objectives

The purpose of this study was to classify determinants of cost increases into two categories, negotiable factors and non-negotiable factors, in order to identify the determinants of health care expenditure increases and to clarify the contribution of associated factors selected based on a literature review.

Methods

The data in this analysis was from the statistical yearbooks of National Health Insurance Service, the Economic Index from Statistics Korea and regional statistical yearbooks. The unit of analysis was the annual growth rate of variables of 16 cities and provinces from 2003 to 2010. First, multiple regression was used to identify the determinants of health care expenditures. We then used hierarchical multiple regression to calculate the contribution of associated factors. The changes of coefficients (R²) of predictors, which were entered into this analysis step by step based on the empirical evidence of the investigator could explain the contribution of predictors to increased medical cost.

Results

Health spending was mainly associated with the proportion of the elderly population, but the Medicare Economic Index (MEI) showed an inverse association. The contribution of predictors was as follows: the proportion of elderly in the population (22.4%), gross domestic product (GDP) per capita (4.5%), MEI (-12%), and other predictors (less than 1%).

Conclusions

As Baby Boomers enter retirement, an increasing proportion of the population aged 65 and over and the GDP will continue to increase, thus accelerating the inflation of health care expenditures and precipitating a crisis in the health insurance system. Policy makers should consider providing comprehensive health services by an accountable care organization to achieve cost savings while ensuring high-quality care.

Summary

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Has Income-related Inequity in Health Care Utilization and Expenditures Been Improved? Evidence From the Korean National Health and Nutrition Examination Survey of 2005 and 2010: Eunkyoung Kim, Soonman Kwon, Ke Xu; J Prev Med Public Health. 2013;46(5):237-248. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.237

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Abstract PDF

Objectives

The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea.

Methods

We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners.

Results

The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010.

Conclusions

We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

Summary

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Special Articles

A Strategy Toward Reconstructing the Healthcare System of a Unified Korea: Yo Han Lee, Seok-Jun Yoon, Seok Hyang Kim, Hyun-Woung Shin, Jin Yong Lee, Beomsoo Kim, Young Ae Kim, Jangho Yoon, Young Seok Shin; J Prev Med Public Health. 2013;46(3):134-138. Published online May 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.3.134

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Abstract PDF

This road map aims to establish a stable and integrated healthcare system for the Korean Peninsula by improving health conditions and building a foundation for healthcare in North Korea through a series of effective healthcare programs. With a basic time frame extending from the present in stages towards unification, the roadmap is composed of four successive phases. The first and second phases, each expected to last five years, respectively, focus on disease treatment and nutritional treatment. These phases would thereby safeguard the health of the most vulnerable populations in North Korea, while fulfilling the basic health needs of other groups by modernizing existing medical facilities. Based on the gains of the first two phases, the third phase, for ten years, would prepare for unification of the Koreas by promoting the health of all the North Korean people and improving basic infrastructural elements such as health workforce capacity and medical institutions. The fourth phase, assuming that unification will take place, provides fundamental principles and directions for establishing an integrated healthcare system across the Korean Peninsula. We are hoping to increase the consistency of the program and overcome several existing concerns of the current program with this roadmap.

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Non-Communicable Diseases and Transitioning Health System in the Democratic People’s Republic of Korea during COVID-19 Lockdown
Jin-Won Noh, Kyoung-Beom Kim, Ha-Eun Jang, Min-Hee Heo, Young-Jin Kim, Jiho Cha
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Systematic review of evidence on public health in the Democratic People’s Republic of Korea
John J Park, Ah-Young Lim, Hyung-Soon Ahn, Andrew I Kim, Soyoung Choi, David HW Oh, Owen Lee-Park, Sharon Y Kim, Sun Jae Jung, Jesse B Bump, Rifat Atun, Hee Young Shin, Kee B Park
BMJ Global Health.2019; 4(2): e001133. CrossRef
Awareness of Korean Unification and Health Care in Healthcare Professional Students
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Lessons From Unified Germany and Their Implications for Healthcare in the Unification of the Korean Peninsula: Gun-Chun Ryu; J Prev Med Public Health. 2013;46(3):127-133. Published online May 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.3.127; Correction in: J Prev Med Public Health 2013;46(4):210

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Abstract PDF

This study investigated the German experience in the transition to a unified health care system and suggests the following implications for Korea. First, Germany could have made use of the unification process better if there had been a good road map. Therefore Korea must develop a well prepared road map that considers all possible situations. Second, Germany saw an opportunity for the improvement of the health care system in the early stage of unification but could not take advantage of it because the situation changed dramatically and they had not sufficiently prepared for it. Korea should take into account the opportunity for improvement of the present health care system, such as the roles of public health and traditional medicine. Thirdly, the conditions f North Korea seem to be far worse than those of former East Germany and also worse than even those of other transition countries. Therefore Korea should design a long-term road map taking as many variables into account as possible, including the different rigid way of thinking and the interrelationship among the social sectors. Fourthly, during the German reunification unexpected factors changed the direction of the events. Korea should have a separate plan for the unexpected factors.

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Original Articles

Improving the Performance of Risk-adjusted Mortality Modeling for Colorectal Cancer Surgery by Combining Claims Data and Clinical Data: Won Mo Jang, Jae-Hyun Park, Jong-Hyock Park, Jae Hwan Oh, Yoon Kim; J Prev Med Public Health. 2013;46(2):74-81. Published online March 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.2.74

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Abstract PDF

Objectives

The objective of this study was to evaluate the performance of risk-adjusted mortality models for colorectal cancer surgery.

Methods

We investigated patients (n=652) who had undergone colorectal cancer surgery (colectomy, colectomy of the rectum and sigmoid colon, total colectomy, total proctectomy) at five teaching hospitals during 2008. Mortality was defined as 30-day or in-hospital surgical mortality. Risk-adjusted mortality models were constructed using claims data (basic model) with the addition of TNM staging (TNM model), physiological data (physiological model), surgical data (surgical model), or all clinical data (composite model). Multiple logistic regression analysis was performed to develop the risk-adjustment models. To compare the performance of the models, both c-statistics using Hanley-McNeil pair-wise testing and the ratio of the observed to the expected mortality within quartiles of mortality risk were evaluated to assess the abilities of discrimination and calibration.

Results

The physiological model (c=0.92), surgical model (c=0.92), and composite model (c=0.93) displayed a similar improvement in discrimination, whereas the TNM model (c=0.87) displayed little improvement over the basic model (c=0.86). The discriminatory power of the models did not differ by the Hanley-McNeil test (p>0.05). Within each quartile of mortality, the composite and surgical models displayed an expected mortality ratio close to 1.

Conclusions

The addition of clinical data to claims data efficiently enhances the performance of the risk-adjusted postoperative mortality models in colorectal cancer surgery. We recommended that the performance of models should be evaluated through both discrimination and calibration.

Summary

Citations

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Selecting the Best Prediction Model for Readmission: Eun Whan Lee; J Prev Med Public Health. 2012;45(4):259-266. Published online July 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.4.259

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Abstract PDF

Objectives

This study aims to determine the risk factors predicting rehospitalization by comparing three models and selecting the most successful model.

Methods

In order to predict the risk of rehospitalization within 28 days after discharge, 11 951 inpatients were recruited into this study between January and December 2009. Predictive models were constructed with three methods, logistic regression analysis, a decision tree, and a neural network, and the models were compared and evaluated in light of their misclassification rate, root asymptotic standard error, lift chart, and receiver operating characteristic curve.

Results

The decision tree was selected as the final model. The risk of rehospitalization was higher when the length of stay (LOS) was less than 2 days, route of admission was through the out-patient department (OPD), medical department was in internal medicine, 10th revision of the International Classification of Diseases code was neoplasm, LOS was relatively shorter, and the frequency of OPD visit was greater.

Conclusions

When a patient is to be discharged within 2 days, the appropriateness of discharge should be considered, with special concern of undiscovered complications and co-morbidities. In particular, if the patient is admitted through the OPD, any suspected disease should be appropriately examined and prompt outcomes of tests should be secured. Moreover, for patients of internal medicine practitioners, co-morbidity and complications caused by chronic illness should be given greater attention.

Summary

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Special Articles

Korean National Health Insurance Value Incentive Program: Achievements and Future Directions: Sun Min Kim, Won Mo Jang, Hyun Ah Ahn, Hyang Jeong Park, Hye Sook Ahn; J Prev Med Public Health. 2012;45(3):148-155. Published online May 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.3.148

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Abstract PDF

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poor-quality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.

Summary

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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

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Abstract 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.

Summary

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Original Article

Disparities in Health Care Utilization Among Urban Homeless in South Korea: A Cross-Sectional Study: Changgyo Yoon, Young-Su Ju, Chang-yup Kim; J Prev Med Public Health. 2011;44(6):267-274. Published online November 14, 2011; DOI: https://doi.org/10.3961/jpmph.2011.44.6.267

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Abstract PDF

Objectives

We examined health care disparities in Korean urban homeless people and individual characteristics associated with the utilization of health care.

Methods

We selected a sample of 203 homeless individuals at streets, shelters, and drop-in centers in Seoul and Daejeon by a quota sampling method. We surveyed demographic information, information related to using health care, and health status with a questionnaire. Logistic regression analysis was adopted to identify factors associated with using health care and to reveal health care disparities within the Korean urban homeless population.

Results

Among 203 respondents, 89 reported that they had visited health care providers at least once in the past 6 months. Twenty persons (22.5%) in the group that used health care (n = 89) reported feeling discriminated against. After adjustment for age, sex, marital status, educational level, monthly income, perceived health status, Beck Depression Inventory score, homeless period, and other covariates, three factors were significantly associated with medical utilization: female sex (adjusted odds ratio [aOR, 15.95; 95% CI, 3.97 to 64.04], having three or more diseases (aOR, 24.58; 95% CI, 4.23 to 142.78), and non-street residency (aOR, 11.39; 95% CI, 3.58 to 36.24).

Conclusions

Health care disparities in Seoul and Daejeon homeless exist in terms of the main place to stay, physical illnesses, and gender. Under the current homeless support system in South Korea, street homeless have poorer accessibility to health care versus non-street homeless. To provide equitable medical aid for homeless people, strategies to overcome barriers against health care for the street homeless are needed.

Summary

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Special Article

How to Improve Influenza Vaccination Rates in the U.S.: Byung-Kwang Yoo; J Prev Med Public Health. 2011;44(4):141-148. Published online July 29, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.4.141

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Abstract PDF

Annual epidemics of seasonal influenza occur during autumn and winter in temperate regions and have imposed substantial public health and economic burdens. At the global level, these epidemics cause about 3-5 million severe cases of illness and about 0.25-0.5 million deaths each year. Although annual vaccination is the most effective way to prevent the disease and its severe outcomes, influenza vaccination coverage rates have been at suboptimal levels in many countries. For instance, the coverage rates among the elderly in 20 developed nations in 2008 ranged from 21% to 78% (median 65%). In the U.S., influenza vaccination levels among elderly population appeared to reach a "plateau" of about 70% after the late 1990s, and levels among child populations have remained at less than 50%. In addition, disparities in the coverage rates across subpopulations within a country present another important public health issue. New approaches are needed for countries striving both to improve their overall coverage rates and to eliminate disparities.

This review article aims to describe a broad conceptual framework of vaccination, and to illustrate four potential determinants of influenza vaccination based on empirical analyses of U.S. nationally representative populations. These determinants include the ongoing influenza epidemic level, mass media reporting on influenza-related topics, reimbursement rate for providers to administer influenza vaccination, and vaccine supply. It additionally proposes specific policy implications, derived from these empirical analyses, to improve the influenza vaccination coverage rate and associated disparities in the U.S., which could be generalizable to other countries.

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English Abstract

The Effect of Outpatient Cost Sharing on Health Care Utilization of the Elderly.: Myunghwa Kim, Soonman Kwon; J Prev Med Public Health. 2010;43(6):496-504.; DOI: https://doi.org/10.3961/jpmph.2010.43.6.496

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Abstract PDF

OBJECTIVES
The purpose of this study was to analyze the effect of outpatient cost-sharing on health care utilization by the elderly. METHODS: The data in this analysis was the health insurance claims data between July 1999 and December 2008 (114 months). The study group was divided into two age groups, namely 60-64 years old and 65-69 years old. This study evaluated the impact of policy change on office visits, the office visits per person, and the percentage of the copayment-paid visits in total visits. Interrupted time series and segmented regression model were used for statistical analysis. RESULTS: The results showed that outpatient cost-sharing decreased office visits, but it also decreased the percentage of copayment-paid visits, implying that the intensity of care increased. There was little difference in the results between the two age groups. But after the introduction of the coinsurance system for those patients under age 65, office visits and the percentage of copayment-paid visits decreased, and the 60-64 years old group had a larger decrease than the 65-69 years old group. CONCLUSIONS: This study evaluated the effects of outpatient cost-sharing on health care utilization by the aged. Cost sharing of the elderly had little effect on controlling health care utilization.

Summary

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Original Article

Perceived Service Quality among Outpatients Visiting Hospitals and Clinics and Their Willingness to Re-utilize the Same Medical Institutions.: Minsoo Jung, Keon Hyung Lee, Mankyu Choi; J Prev Med Public Health. 2009;42(3):151-159.; DOI: https://doi.org/10.3961/jpmph.2009.42.3.151

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Abstract PDF

OBJECTIVES
This study was to determine how the perception and the satisfaction of outpatients who utilized clinics and hospitals are structurally related with their willingness to utilize the same institution in the future. METHODS: Three hundred and ten responses (via convenient sampling) were collected from 5 hospitals and 20 clinics located in Seoul listed in the "Korea National Hospital Directory 2005". Service quality was utilized as the satisfaction measurement tool. For analysis, we used a structural equation modeling method. RESULTS: The determining factors for general satisfaction with medical services are as follows: medical staff, reasonability of payment, comfort and accessibility. Such results may involve increased competition in the medical market and increased demands for quality medical services, which drive the patients to visit hospitals on their own on the basis of changed determining factors for satisfaction. CONCLUSIONS: The structural equation model showed that the satisfaction of outpatients with the quality of medical services is influenced by a few sub-dimensional satisfaction factors. Among these sub-dimensional satisfaction factors, the satisfaction with medical staff and payment were determined to exert a significant effect on overall satisfaction with the quality of medical services. The structural relationship in which overall satisfaction perceived by patients significantly influences their willingness to use the same institution in the future was also verified.

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English Abstract

Educational Differences in Health Care Utilization in the Last Year of Life among South Korean Cancer Patients.: Soo Young Choo, Sang Yi Lee, Chul Woung Kim, Su Young Kim, Tae Ho Yoon, Hai Rim Shin, Ok Ryun Moon; J Prev Med Public Health. 2007;40(1):36-44.; DOI: https://doi.org/10.3961/jpmph.2007.40.1.36

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Abstract PDF

OBJECTIVES
There have been few studies examining the differences in health care utilization across social classes during the last year of life. Therefore, in this study we analyzed the quantitative and qualitative differences in health care utilization among cancer patients across educational classes in their last year of life, and derived from it implications for policy. METHODS: To evaluate health care utilization by cancer patients in the last year of life, Death certificate data from 2004 were merged with National Health Insurance data (n=60,088). In order to use educational level as a social class index, we selected the individuals aged 40 and over as study subjects (n=57,484). We analyzed the differences in the medical expenditures, admission days, and rates of admission experience across educational classes descriptively. Multiple regression analysis was conducted to evaluate the association between medical expenditures and independent variables such as sex, age, education class, site of death and type of cancer. RESULTS: The upper educational class spent much more on medical expenditures in the last one year of life, particularly during the last month of life, than the lower educational class did. The ratio of monthly medical expenditures per capita between the college class and no education class was 2.5 in the last 6-12 months of life, but the ratio was 1.6 in the last 1 month. Also, the lower the educational class, the higher the proportion of medical expenditures during the last one month of life, compared to total medical expenditures in the last one year of life. The college educational class had a much higher rate of admission experiences in tertiary hospitals within Seoul than the other education classes did. CONCLUSIONS: This study shows that the lower educational classes had qualitative and quantitative disadvantages in utilizing health care services for cancer in the last year of life.

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Original Articles

The Causality among the Internal Customer Satisfaction, the External Customer Satisfaction and the Customer Loyalty of Medical Service.: Sookyung Paik; Korean J Prev Med. 2002;35(3):236-244.

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Abstract PDF: OBJECTIVE
To empirically investigate the relationship of internal and external customer satisfactions, service quality, and customer loyalty in medical services. METHODS: This essay proposes an integrated model to explain the causality of internal and external customer satisfactions, service quality, and customer loyalty. To this end, a structural model was developed, consisting of the following factors: internal and external customer satisfactions, service quality, and customer loyalty. The study included 214 sets of data, with 107 sets being collected for both out-patients and in-patients. The data were analyzed using AMOS 4.0. RESULTS: We found the greater the internal customer satisfaction, the greater the out-patient quality of service quality. Secondly, the greater the service quality, the greater the external customer satisfaction of both in- and out-patients. The service quality of doctors, compared to that of the nurses, had a greater effect on external customer satisfaction. Thirdly, the service quality of doctors and nurses affected both internal and external customer satisfactions, which ultimately affected the customer loyalty. Finally the greater the external customer satisfaction, the greater the customer loyalty. CONCLUSION: This study confirms the positive relationship among the internal and external customer satisfactions, service quality, and customer loyalty, which proves the doctors quality of service is the primary factor for external satisfaction, and customer loyalty relating to medical services.; Summary

Information Searching Behavior of Health Care Consumers by Sociodemographic Characteristics.: Yoomi Chae, Sunhee Lee, Woohyun Cho; Korean J Prev Med. 2001;34(4):389-398.

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Abstract PDF: OBJECTIVES
To investigate the information searching behavior of health care consumers according to sociodemographic characteristics. METHODS: A questionnaire survey was conducted of 1,507 persons who were selected through a multi-stage stratified area cluster sampling of the Republic of Korea, excluding the province of Jeju-do. Personal were conducted through a door-to-door survey between 27 July and 10 August 1999. RESULTS: 80.5% of respondents used more than one source of information and those 40~59 years of age, female, a housewife or student and those who claimed a religion demonstrated more active information searching behavior. A personal informer was used significantly more in those 20~39 years old, female, and those who claimed a religion. Clerical workers, those with post-secondary education and a monthly income greater than 2,000,000 won ($1500) were more actively used a public informer. Low socioeconomic status and older persons used an experimental informer when they chose a health care institution. CONCLUSION: Regardless of the sociodemographic characteristics, personal and experimental informers were the most useful source of information. Because appropriate information was not easy to obtain, the health care consumer was dependent upon word-of-mouth communication(personal informer) when using health care services.; Summary

Dimensions of Consumer Ratings of a Hospital Outpatient Service Quality.: Ki Tae Moon, Seung Hum Yu, Woo Hyun Cho, Dong Kee Kim, Yunwhan Lee; Korean J Prev Med. 2000;33(4):495-504.

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Abstract PDF: OBJECTIVES
To examine various dimensions of consumer ratings of health care service with factor analysis and to find which factors influence the overall quality of health care service. METHODS: A cross-sectional study was conducted on outpatients of a general hospital located in Sungnam City. A self-administered questionnaire was used to assess the consumer? ratings of health care service received. The response rate was 92.8% with a total of 537 persons completing the questionnaire. Factor analysis was performed on 34 items evaluating the quality of health care service. Items were grouped into 5 dimensions as a result of factor analysis and the reliability and validity of influence on patient service assessment were evaluated for each dimension. RESULTS: The 5 dimensions were as follows ; 1) physician services, 2) non-physician services, 3) process 4) facilities, and 5) cleanliness. A positive correlation with the quality of health care service was found for the dimensions of non-physician services and process, while no significant correlation was found for the dimensions of physician services, facilities, and cleanliness. CONCLUSIONS: The result of this study may provide basic information for the development of future self-administered questionnaires of consumer ratings and for the evaluation of quality improvement activities in hospital outpatient settings.; Summary

Self-Rating Perceived Health: The Influence on Health Care Utilization and Death Risk.: Sun Seog Kweon, Sang Yong Kim, Jeong Soo Im, Seok Joon Sohn, Jin Su Choi; Korean J Prev Med. 1999;32(3):355-360.

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Abstract PDF: OBJECTIVES
This 3-year longitudinal study was conducted to evaluate the influence of self-rating health perception on health care utilization and all cause-death risk. METHODS: The hypothesis was tested using a community-based samples, among which subjects 3,414 were interviewed in 1995. Self-rating health perception was assessed by single-item question. Three components of health care utilization amount(number of visits, number of medications, yearly health care expenses) per year were measured using medical insurance data during 3-year follow-up period among subjects in district health care insurance. There were 123 deaths from all causes among 3,085 subjects interviewed. RESULTS: The results showed that those who had poor health perception revealed more increases in the amount of health care utilization than good health perception group (p<0.05). After adjusting for age and sex, the poor health perception group had higher death risk over 3 years than good health perception group(hazard ratio=1.88). but, after adjusting health care utility, supplementary, was not significant. CONCLUSION: These results suggest that self-rating health percep-tion was associated with difference in health care utilization and all cause-death risk.; Summary

Health Care Utilization of Workers with Skin Disease in Inchon.: Yeon Soon Ahn, Jae Seok Song, Jong Uk Won, Jaehoon Roh; Korean J Prev Med. 1999;32(2):206-214.

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Abstract PDF: OBJECTIVES
This study was carried out to identify relation of health care utilization due to skin disease(ICD-10, L00-L99) and characteristics(sex, age, exposure status, type of industry, size of enterprise) of workers. METHODS: We made new database composed of 30,536 workers' health examination results in one specific health examination institute in Inchon and data of medical insurance utilization due to skin disease in 4 medical insurance associations for enterprise from January, 1995 to December, 1997. And we analyzed determinants of health care utilization due to skin disease of workers. RESULTS: Among 30,536 study subjects, 8,837(28.9%) workers and 4,181(13.7%) workers utilized medical insurance due to total skin disease(ICD-10, L00-L99) and contact dermatitis(ICD-10, L23-L25), respectively. Female workers(p<.001), workers exposed to organic solvents(p<.05), workers in manufacturing industries(p<.05, p<.01, respectively) and in large scale enterprises(p<.001) utilized more medical insurance due to total skin disease and contact dermatitis than male workers, workers not exposed to organic solvents, workers in non-manufacturing industries and small scale enterprises. With multiple logistic regression analysis, significant explanatory variables affecting workers' medical utilization due to total skin disease and dermatitis and eczema(ICD-10, L20-L30) in total workers were sex, age, specific chemicals and size of enterprises. And age, type of industries, organic solvents, specific chemicals and size of enterprises were significant explanatory variables related to medical insurance utilization due to dermatitis and eczema and contact dermatitis in male workers. CONCLUSION: From the above results, we found that workers exposed to organic solvents utilized more medical insurance due to skin disease than workers not exposed to. And, comparing to workers in large scale enterprises, workers in small scale enterprises may have unmet medical care utilization due to skin disease. Therefore we have to establish counterplan to manage occupational skin disease of high risk group(organic solvent exposure group) and to satisfy unmet medical care utilization of workers in small scale enterprises.; 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

Study on activities of some occupational health nurses in Kyungnam area.: Young Sook Kim, Hae Sook Shon, Jeong Hak Kang, Chang Hee Lee, Chae Un Lee; Korean J Prev Med. 1995;28(3):576-587.

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Abstract PDF: Authors purposed to observe activities of occupational health nurses and it's related factors, and to suggest the way that induct better occupational health nurses' activities with questionnaire to 87 occupational health nurses who individually work as health manager in the plant. The questionnaire included type of plant and number of workers, general characteristics, work conditions, activities, etc. Major findings are as follows. 1. 82.8% of occupational health nurses were third decade 93.1% graduated junior college or college. And 82.8% were not married. 2. General work conditions: 40.2% were belonged to safety-health section, 98.85% were mere clerks. 60.9% worked less than weekly 44 hours, and an annual salary of 50.6% was between 10million and 14 million won. 3. work condition related to health manager work: there was separated health care room in 94. 3%, working period as health manager(occupational health nurse) was less than 5 years in 70.1%, 49.4% had the out-of-health manager work. In 87.4%, occupational physician was appointed, only 6.9% of them were full time, 52.9% of them worked little in the plants The problems related to workers' health were discussed with industrial nurses in 88.5%. 4. Attitude for their work: 88.5% were thought that their work is important for workers' health care, 57.5% satisfied to work as health manager. In 51.7%, motive to being industrial nurse were the appropriate aptitude. 5. Activities: General medical care in 100 % were carried out, in 97 7% works related to general health examination, in l00% works related to special health examination were carried. But works related to use of protective apparatus were carried out in 20.8%. 6. Factors related to level of activities: In cases who solved the health related problems by themselves, the level of activities was significantly higher than in others. In cases there w ere full time occupational physician, the level of activities was significantly lower. 7. Occupational health nurse's needs: 100% wanted regular education, 89.7% wanted the qualifying examination. As the results, author suggests that the right of self-control is given to occupational health nurses and the work of occupational physician is clearly defined for the induction of the better activities of occupational health nurses.; Summary

An Empirical Analysis of Price Elasticity of the Demand for Medical Care Services in Korean National Health Insurance Program.: Chunbae Kim, Dosung Lee, Hanjoong Kim, Myongsei Sohn; Korean J Prev Med. 1995;28(2):450-461.

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Abstract PDF: This paper tested by using Micro TSP, an empirical econometric analysis to approve officially a hypothesis of price elasticity of the demand for medical care services in Korean national medical insurance and the economic effect of health care delivery system with time-series datas of Medical Insurance statistical yearbook(1981-1993). The results suggest that the korean medical insurance system shows moral hazard due to the change of coinsurance and the economic effect according to intervention of the health care delivery system, but it is different by insurers regardless of the same structure of the medical insurance scheme.; Summary

Trend and Prediction of Urban Family Expenditure for Health Care.: Jae Yong Park, Si Hyun Nam; Korean J Prev Med. 1995;28(2):347-363.

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Abstract PDF: The increase of health care expenditures is an important problem in the almost countries. Also, suppression of the health care expenditures is an important problem in the health field of Korea since the national health insurance for total people in 1989. Thus, it is very important to grasp the change of the health care expenditures of family and proportions of the health care expenditures to total expenditures of family, because they are the basis of national health care expenditures in Korea. While the health care expenditures of urban family were increased during 1980-1993 by 12.8% annually, the total expenditures of urban family were increased by 14.8% annually. consequently, the proportions of health care expenditures to total expenditures were decreased from 5.98% to 4.76%. The proportions of health care expenditure for 3 years to come were predicted to 4.75% in 1994, 4.67% in 1995, and 4.63% in 1996 by the time-series ana]ysis. That is, it was predicted that they would be decreasing slowly. The product elasticity of health care expenditure was less than 1 in the multiple regression analysis, so the health care is normal good rather than superior good. Therefore, it seems that the household economy is able to bear the expense pursuing the improvement of quality of health care by actualizing the medical insurance fee.; Summary

Impacts of Implementation of Patient Referral System in terms of Medical Expenditures and Medical Utilization.: Sang Hyuk Jung, Han Joong Kim; Korean J Prev Med. 1995;28(1):207-224.

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Abstract PDF: A new medical delivery system which regulated outpatient department(OPD) use from tertiary care hospitals was adopted in 1989. Under the new system, patients using tertiary care hospital OPD without referral slip from clinics or hospital could not get any insuranced benefit for the services received from the tertiary care hospital. This study was conducted to evaluate the Patient Referral System(PRS) with respect to health care expenditures and utilization. Two data sets were used in this study. One was monthly data set(from January 1986 to December 1992)from the Annual Report of Korea Medical Insurance Corporation(KMIC). The other was monthly joint data set composed of personal data of which 10% were selected randomly with their utilization data of KMIC from January 1988 to December 1992. The data were analyzed by time-series intervention model of SAS-ETS. The results of this study were as follows: 1. There was no statistically significant changes in per capita expenditures following PRS. 2. Utilization episodes per capita was increased statistically significantly after implementation of PRS. The use of clinics and hospitals increased significantly, whereas in tertiary care hospitals the use decreased significantly immediately after implementation of PRS and increased afterwards. 3. Follow-up visits per episode were decreased statistically significantly after implementation of PRS. The decrease of follow-up visits per episode were remarkable in clinics and hospitals, whereas in tertiary care hospitals it was increased significantly after implementation of PRS. 4. There was no statistically significant changes in prescribing days per episode following PRS. Futhermore, clinics and hospitals showed a statistically significant decrease in prescribing days per episode, whereas in tertiary care hospital it shower statistically significant increase after implementation of PRS. 5. Except high income class, the use of tertiary care hospitals showed statistically significant decrease after implementation of PRS. The degree of decrease in the use of tertiary card hospitals was inversely proportional to income. These results suggest that the PRS policy was not efficient because per capita expenditures did not decrease, and was not effective because utilization episodes per capita, follow-up visits per episode, and prescribing days per episode were not predictable and failed to show proper utilization. It was somewhat positive that utilization episodes per capita were decreased temporarily in tertiary card hospitals. And PRS policy was not appropriate because utilization episodes per capita was different among income groups. In conclusion, the PRS should be revised for initial goal attainment of cost containment and proper health care utilization.; Summary

Job Analyses of Health Care Managers in Group Health Care System.: Kyoo Sang Kim, Chong Yon Park, Jaehoon Roh; Korean J Prev Med. 1994;27(4):777-792.

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Abstract PDF: For developing the Group Health care system, health managers' job structure were analysed in the aspects of content, amount, and process. As a trial research, data were collected by a standardized job analysis table to 6 doctors, 40 nurses, and 11 industrial hygienists of Group Health Care System. Health care managers were performing complex and intellectual jobs such as health education for workers, managing health care, conference as well as more simple jobs like as filling diary. Especially, job was consisted of general job and health care management job in the proportion of 1:2.18. The major general job were data management related with the health statistics, and major health care management jobs were managing health care, health counselling, environmental management of working sites. Each specific jobs were required differentiated intellectual capacity, creativity, autonomy, psychic stress, and physical work; most respondents perceived that health care management jobs should require more inputs than general jobs Additionally job satisfaction and perceived need on specific job items were analysed. Results of this research, suggested through the field experiences in working sites, should be considered for improving the Group Health Care System.; Summary

The Korean Health Care Delivery System Early in the 21st Century.: Dal Sun Han; Korean J Prev Med. 1994;27(2):186-193.

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Abstract PDF: This paper is an attempt to identify major challenges to be faced by the Korean health care delivery system for about 30 year in the future and to deliberate over possible policy responses to them. It is not intended to make a precise prediction of the future profile of the system, but the focus is given to understanding what we have to do from now on in order to develop health care in Korea toward a desirable direction. Although the discussion has been made in a rather fragmented manner, it would hopefully provide stepping stones for a systematic study of the Korean health care system from a long range perspective.; Summary

A Study on the Criteria for Selection of Medical Care Facilities.: Woo Hyun Cho, Han Joong Kim, Sun Hee Lee; Korean J Prev Med. 1992;25(1):53-63.

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Abstract PDF: There are increasing interest and need for information on health care consumer with the significance of hospital marketing and strategic planning being increasingly emphasized. This study was conducted to investigate the criteria for selection of medical facilities according to the characteristics of health care consumer by the types of medical services on a sample of 1,500 population aged 20 years and above. Major findings are as follows; 1. When considering the criteria for selection of medical facilities into two factors, namely, quality or convenience factors, convenience factor was the major contributor for outpatient and dental services whereas it was quality factor for inpatient services. 2. Females and those residing in large cities selected medical facilities based on convenience factor in the outpatient services. In the case of inpatient service, persons who considered their present health status to be good and whose ages were 50 years old and above choose medical facilities based on quality factor. 3. Persons who considered medical facilities to be profit-making tended to choose medical facilities based on convenience factor for outpatient services. There were no differences in the cases of inpatient and dental services. 4. There was no significant difference on the criteria for selection of medical facilities according to the decision maker for selection or trust on medical facilities. On the use of health service information, selection of medical facilities was based on qPality factor for those who made more use of the information in the cases of outpatient and dental services. 5. Analysis using the logistic regression model on the criteria for the selection of medical facilities with the characteristics of health care consumer as independent variables was performed. The selection of medical facilities was significantly related with residential area, sex, and use of information on medical facilities for outpatient services and with age, average monthly income, and perception of health status for inpatient services. For dental services significant association with residential area and use of information on medical facilities was seen. The results of this study, despite some limitations, can be used as baseline data for marketing and strategic planning of hospital management.; Summary

A Study on the Insurance Contribution and Health Care Utilization of the Regional Medical Insurance Scheme.: Sang Il Lee, Hyun Rim Choi, Hyeong Sik Ahn, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 1989;22(4):578-590.

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Abstract PDF: This study was conducted to assess the equity in the regional insurance scheme through analysis of the computerized data from one regional insurance society and National Federation of Medical Insurance. We analysed the insurance contribution and benefit by the classes based on total and income-related contribution per household. The major findings of this study are as follows: 1. The average proportion of income-related contribution among the total was 39.2% and the upper classes show higher proportion of the income-related contribution. 2. The upper classes show higher health care utilization rate than the lower classes. It suggests that the lower classes have relatively large unmet medical needs. 3. The analysis through the Lorenz curve reveals that there exists transference of contributions from the upper to lower classes. But the cumulative percentage of insurance benefit is smaller than that of the number of the insured. It implies that regional medical insurance scheme in Korea has still some inequity in the context of social security principles.; Summary

Comparative Study

Differences in Medical Care Utilization Rates of the Disabled and the Non-disabled with Ambulatory Care Sensitive Conditions.: Sang Jun Eun, Jee Young Hong, Jin Yong Lee, Jin Seok Lee, Yoon Kim, Yong Ik Kim, Youngsoo Shin; J Prev Med Public Health. 2006;39(5):411-418.

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Abstract PDF: OBJECTIVES
The purpose of this study was to determine whether the disabled have worse access to primary care than the non-disabled. METHODS: We used the National Disability Registry data and the National Health Insurance data for the calendar year 2003, and we analyzed 807,380 disabled persons who had been registered until December 2001 and we also analyzed 1,614,760 non-disabled persons for nine ambulatory care sensitive conditions (ACSCs). The rates of physician visits and hospitalizations for the patients with ACSCs were compared between the disabled and the nondisabled. Multiple logistic regression analysis was used to evaluate the association between medical care utilization and disability and to assess the association between hospitalization and the number of physician visits while controlling for potential confounders. RESULTS: The numbers of physician visits per 100 patients were 0.78~0.97 times lower for the disabled than that for the non-disabled with five of nine ACSCs. The numbers of hospitalizations per 100 patients were 1.16~1.77 times higher for the disabled than that for the non-disabled with all the ACSCs. While the ORs of a physician visit for the disabled were significantly lower than that for the non-disabled with all the ACSCs (OR: 0.44~0.70), and the ORs of hospitalization for the disabled were significantly higher (OR: 1.16~1.89). The lower physician visit group (number of physician visits < or =1) was more likely to be hospitalized than the higher physician visit group (number of physician visits > or =2) (OR: 1.69~19.77). The effect of the physician visit rate on hospitalization was larger than the effect of disability on hospitalization. CONCLUSIONS: The results suggest that the disabled were more likely to be hospitalized for ACSCs due to their lower access to primary care.; Summary

English Abstract

Out-of-pocket Health Expenditures by Non-elderly and Elderly Persons in Korea.: Sung Gyeong Kim, Seung Hum Yu, Woong Sub Park, Woo Jin Chung; J Prev Med Public Health. 2005;38(4):408-414.

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Abstract PDF: OBJECTIVES
The purpose of this study was to determine the impact of the sociodemographic and health characteristics on the out-of-pocket health spending of the individuals aged 20 and older in Korea. METHODS: We used the data from the 2001 National Public Health and Nutrition Survey. The final sample size was 26, 154 persons. Multiple linear regression models were used according to the age groups, that is, one model was used for those people under the age of sixty-five and the other was used for those people aged sixty-five and older. In these analyses, the expenditures were transformed to a logarithmic scale to reduce the skewness of the results. RESULTS: Out-of-pocket health expenditures for those people under the age of 65 averaged 14, 800 won per month, whereas expenditures for those people aged 65 and older averaged 27, 200 won per month. In the regression analysis, the insurance type, resident area, self-reported health status, acute or chronic condition and bed-disability days were the statistically significant determinants for both age groups. Gender and age were statistically significant determinants only for the non-elderly. CONCLUSIONS: The findings from this study show that the mean out-of-pocket health expenditures varied according to the age groups and also several diverse characteristics. Thus, policymakers should consider the out-of-pocket health expenditure differential between the elderly and nonelderly persons. Improvement of the insurance coverage for the economically vulnerable subgroups that were identified in this study should be carefully considered. In addition, it is necessary to assess the impact of out-of-pocket spending on the peoples' health care utilization.; Summary

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