Journal of Preventive Medicine and Public Health

Original Article

Effects of the Out-of-pocket Payment Exemption in the Public Health Center on Medical Utilization of the Korean Elderly: Kiryong Nam, Eunhye Park, Yuhjin Chung, Chang-yup Kim; J Prev Med Public Health. 2020;53(6):455-464. Published online October 20, 2020; DOI: https://doi.org/10.3961/jpmph.20.341

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Objectives
The distribution of hospitals in Korea is unbalanced in terms of accessibility. Many local public health centers (PHCs) exempt out-of-pocket payments (OOPs) based on local government laws to increase coverage. However, this varies across administrative regions, as many make this exemption for the elderly, while others do not. This study aimed to evaluate the effects of the OOP exemption at local PHCs among elderly individuals.
Methods
This study used online data on Korean national law to gather information on individual local governments’ regulations regarding OOP exemptions. Individual-level data were gathered from the 2018 Community Health Survey and regional-level data from public online sources.
Results
The study analyzed 132 regions and 44 918 elderly people. A statistical analysis of rate differences and 2-level multiple logistic regression were carried out. The rate difference according to whether elderly individuals resided in areas with the OOP exemption was 1.97%p (95% confidence interval [CI], 1.07 to 2.88) for PHC utilization, 1.37%p (95% CI, 0.67 to 2.08) for hypertension treatment, and 2.19%p (95% CI, 0.63 to 3.74) for diabetes treatment. The regression analysis showed that OOP exemption had an effect on hypertension treatment, with a fixed-effect odds ratio of 1.25 (95% CI, 1.05 to 1.48).
Conclusions
The OOP exemption at PHCs can affect medical utilization in Korea, especially for hypertension treatment. The OOP exemption should be expanded to improve healthcare utilization in Korea.

Summary

Citations

Citations to this article as recorded by

Access of older people to primary health care in low and middle-income countries: A systematic scoping review
Saydeh Dableh, Kate Frazer, Diarmuid Stokes, Thilo Kroll, Dirceu Henrique Paulo Mabunda
PLOS ONE.2024; 19(4): e0298973. CrossRef

Evaluation Studies

The Factors Implicated When an Individual Starts to Smoke Again After a 6 Month Cessation.: Hyo Kyung Son, Un Young Jung, Ki Soo Park, Sin Kam, Sun Kyun Park, Won Kee Lee; J Prev Med Public Health. 2009;42(1):42-48.; DOI: https://doi.org/10.3961/jpmph.2009.42.1.42

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Abstract PDF

OBJECTIVES
This study was conducted to examine the factors implicated when people start smoking again after a 6 month cessation, and was carried out at the smoking cessation clinic of a public health center. METHODS: The study subjects were 191 males who had attended the smoking cessation clinic of a public health center for 6 months in an attempt to quit smoking. Data was collected, by phone interview, regarding individual smoking habits, if any, over the 6 month study period. The factors which may have caused an individual to smoke again were examined. This study employed a health belief model as it theoretical basis. RESULTS: Following a 6 month cessation, 24.1% of the study group began to smoke again during the 6 month test period. In a simple analysis, the factors related to individuals relapsing and smoking again included barriers of stress reduction, body weight gain and induction of smoking by surroundings among perceived barriers factor of our health belief model (p<0.05). In multiple logistic regression analysis for relapsed smoking, significant factors included barriers of stress reduction and induction of smoking by surroundings (p<0.05). The most important reason of for an individual to relapse into smoking was stress (60.9%) and the most likely place for a relapse to occur was a drinking establishment (39.1%). CONCLUSIONS: Our results indicate that both regular consultations and a follow-up management program are important considerations in a public health center program geared towards maintaining smoking cessation.

Summary

Citations

Citations to this article as recorded by

Factors associated with long-term smoking relapse in those who succeeded in smoking cessation using regional smoking cessation programs
Seung Hun Lee, Yu Hyeon Yi, Young In Lee, Hyo Young Lee, Kyoung-Min Lim
Medicine.2022; 101(31): e29595. CrossRef
Factors Related to Smoking Recurrence within Six-months Smoking Cessation among Employees in Enterprises with Smaller than 300 Workers
Byung Jun Jin, Chul-Woung Kim, Seung Eun Lee, Hyo-Bin Im, Tae-Yong Lee
Journal of Korean Academy of Community Health Nursing.2021; 32(1): 107. CrossRef
Factors related to the smoking relapse of out-of-school adolescents
Ji Eun Bae, Chul-Woung Kim, Seung Eun Lee, Hyo-Bin Im, In Young Kim, Tae-Yong Lee, Sang-Yi Lee, Myungwha Jang
Korean Journal of Health Education and Promotion.2021; 38(3): 13. CrossRef
Re-smoking and related factors of prisoners after release who were in a forced smoking cessation environment for 1 year or more
Jina Jung, Hae-Sung Nam
Korean Journal of Health Education and Promotion.2019; 36(3): 27. CrossRef
Factors Related to Smoking Relapse among Military Personnel in Korea: Data from Smoking Cessation Clinics, 2015–2017
Eunjoo Kwon, Eun-Hee Nah
Korean Journal of Health Promotion.2018; 18(3): 138. CrossRef
Short-Term Impact of a Comprehensive Smoke-Free Law Following a Partial Smoke-Free Law on PM2.5 Concentration Levels at Hospitality Venues on the Peripheries of College Campuses
Sol Yu, Wonho Yang, Kiyoung Lee, Sungcheon Kim, Kwonchul Ha, Sungroul Kim
International Journal of Environmental Research and Public Health.2015; 12(11): 14034. CrossRef
Factors Associated with Failure in The Continuity of Smoking Cessation Among 6 Month's Smoking Cessation Succeses in the Smoking Cessation Clinic of Public Health Center
Hyeon-Soon Choi, Hae-Sook Sohn, Yun-Hee Kim, Myeong-Jin Lee
Journal of the Korea Academia-Industrial cooperation Society.2012; 13(10): 4653. CrossRef
Smoking Relapse and Related Factors Within One Year Among Successes of the Smoking Cessation Clinics of Public Health Centers
Mi Jag Kim, Ihn Sook Jeong
Journal of Preventive Medicine and Public Health.2011; 44(2): 84. CrossRef
Evidence-based smoking cessation counseling: motivational intervention and relapse prevention
Soon-Woo Park
Journal of the Korean Medical Association.2011; 54(10): 1036. CrossRef
The Patterns and Risk Factors of Smoking Relapse among People Successful in Smoking Cessation at the Smoking Cessation Clinics of Public Health Centers
Yi Soon Kim, Yun Hee Kim
Journal of Korean Academy of Community Health Nursing.2011; 22(4): 365. CrossRef
Factors Associated with Relapse to Smoking Behavior Using Health Belief Model
Hee-Suk Kim, Sang-Soo Bae
Journal of agricultural medicine and community health.2011; 36(2): 87. CrossRef
A Longitudinal Study on the Causal Association Between Smoking and Depression
Eunjeong Kang, Jaehee Lee
Journal of Preventive Medicine and Public Health.2010; 43(3): 193. CrossRef

Original Articles

A Study on Characteristics of Core Projects Described in 3rd Community Health Plans.: Dong Moon Kim, Weon Young Lee, Chang Yup Kim, Ok Ryun Moon; J Prev Med Public Health. 2004;37(1):88-98.

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Abstract PDF: OBJECTIVE
The 3rd community health plan let health centers select and promote core projects considering budget and manpower. This study analyzed the content and selection processes of core projects, using the nationwide 3rd community health plans, to give relevant information on health center policies. METHODS: Classification criteria for content analysis of core projects were established and verified through a literature review and by specialist discussions. Fifty plans were selected by stratified proportional random sampling for regional characteristics. And coding criteria standardized through coding repetition and discussion, by 2 persons (k> 0.7). Using stratified proportional random sampling for 16 cities and provinces, regional characteristics, 117 plans were selected, and the contents of the core project selection processes and program contents analyzed. RESULTS: The survey was used by 59.8 % of samples as a core project decision-making method. The participants included 98.6, 81.4, 40 and 38.6% of the health staffs, residents, medical institutions, and administrators, respectively. Discussion was used by 15.4% of samples. The participants were health staffs by 100% as a great. The ranking of the frequencies of the selected core projects were, in order; chronic disease control, health promotion, elderly health, maternal-child health, and oral health at 16.4, 14.8, 14.3, 12.7 and 11.9%, respectively. Analyses on the chronic disease control and elderly health contents showed the diversity of object disease, high rates of visitors on patient detection programs, high rates of unclear target populations, and the provision of medical exams and treatments as the main services, with high variations in business per-formance. The national health budgets for health centers in 2003 were about 910 and 240 million won for chronic disease control and elderly health, respectively, which were less than for the other five priority core projects. CONCLUSION: The chronic disease control and elderly health at the health centers were not standardized for object disease, patient detection program, target population, service provision, and national support budget was insufficient. Thus it is necessary to develop standard guidelines, and increase financial support, for chronic disease control and elderly health.; Summary

Factors Affecting the Diffusion of Health Center Information System.: Jin Yong Lee, Young Gyoung Do, Jung Gyu Lee, Gi Dong Park, Chang Yup Kim, Yong Ik Kim; Korean J Prev Med. 2003;36(4):359-366.

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Abstract PDF: OBJECTIVES
This study was conducted to review the diffusion process and factors affecting the adoption of the Health Center Information System (HIS). METHODS: Data were collected from POSDATA (private company), MOHW, other Ministries and local governments. To specify the date of adoption, supplementary information was collected from 40 health centers. The following three kinds of factors were analyzed. Internal factors included type, size, and innovativeness of health centers. Community factors were composed of population size, economic status, and level of education. Organizational environmental factors consisted of information score of the municipalities, financial support of the from central government, and the neighborhoodness of innovator health centers. RESULTS: All health centers in the metropolitan cities of Seoul, Gwangju and Jeju adopted the HIS. The laggards were those in the metropolitan cities of Busan (18.8%), Incheon (20.0%) and Daejun (20.0%), and cities with population more than 300, 000 (54.8%) and counties with health center hospitals (47.1%). Financially supported rural health centers adopted the HIS more rapidly than those not supported. The factors identified as being statistically significant (p< 0.05), from a univariate analysis by Kaplan-Meier method, were: (1) internal factors of the type, size and innovativeness of health centers; (2) community factors of population size and economic status; (3) organizational environmental factors of the central government financial support and the neighborhoodness of innovator health centers. A multivariate analysis, using a Cox proportional hazard method, proved the innovativeness of health centers, central government financial support and the neighborhoodness of innovator health centers, were statistically significant (p< 0.05). CONCLUSIONS: The innovativeness of health centers, financial support from central government and the neighborhoodness of innovator health centers, rather than community factors related to regional socioeconomic status, affected the adoption of the HIS in health centers. Further in-depth studies, modifying the MOHW's strategy to propagate the HIS to the laggard health centers, are recommended.; Summary

A Comparative Study on Enhancing the Function of the Heath Center in a urban area.: Weon Young Lee, Young Jeon Shin, Young Jun Kwon, Bo Youl Choi, Ok Ryun Moon, Hye Jeong Jeon; Korean J Prev Med. 1998;31(4):857-874.

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PDF: Summary

A Study on Service Characteristics of Directors of Health Centers in Korea.: Jae Won Yoo, Ok Ryun Moon, Sang Yi Lee, Chul Woung Kim, Sang Gu Yi; Korean J Prev Med. 1998;31(4):786-800.

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Abstract PDF: This study has attempted to show general characteristics of health centre directors who have served the post of directorship during the last 40 years. Of 3,000 such health centre directors, information on about 2,500 directors was collected. While average length of service for health center directors has increased, that of vacancy period has decreased. Rural areas have a shorter average length of service than the urban area. Rural areas have twice longer length of vacancy period per health center. Kangwon-do has the longest average length of vacancy period since 1980(2.79 months/year), and Daejeon has the shortest length of vacancy period(0.21 months/year). Chung-buk has no physician directors. The civil servant's rank for the directorship has promoted from the fifth level to the fourth level since 1990. A comparison between the physician director and non-physician director was made as follows : First, the proportion of physician directors had maintained rather high before 1980s ; 62.5% in 1963, 78.3% in 1970, 70.4% in 1980. It decreased to 44.1% in 1990 and 47.6% in 1997. Instead, non-physician directors has abruptly increased since 1980s(12.4% in 1980, 55.4% in 1990 and 50.8% in 1997). Second, physician directors mainly locate in the urban area(58.0% in 1997), but non-physician directors mainly in the rural area(67.2% in 1997). Third, since 1980, the average length of service for physician directors and for non-physician directors has become similar. Fourth, the mean age of physician directors is 45.1 years, and that of non-physician directors 55.7 years. The latter is 10 years older than the former.; Summary

The relationship between the utilization of health center and exposed amount to solvent by using cumulative exposure index.: Ju Won Park, Soon Young Lee, Jae Yeon Jang, Kyung Jong Lee, Ho Grun Jeong; Korean J Prev Med. 1998;31(3):404-413.

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Abstract PDF: This study was conducted in order to clarify the factors affecting the number of utilization to health center for the shipyard workers who have been work in exposed environment to solvent. At first the tendencies of the number of utilization to health center in accordance with cumulative exposure(CE), lifetime weighted average exposure(LWAE), one's place of duty, work contents, states of using safety apparatus, the degree of the knowledge on handling solvents, exposure year. 1) The increase in the cumulative exposure(CE) was significantly higher in the number of utilization to health center. The group with longer exposure year showed significantly higher number of utilization to health center(p<0.01). Considering the work contents such as power blasting, spray, mixing and touch-up, the group of touch-up showed higher number of utilization to health center and this difference was statistically significant(p<0.001). Those who were not using the safety apparatus, showed higher number of utilization to health center, which was statistically significant(p<0.05). The degree of the knowledge on handling the solvent had no relation with using health center. 2) The results conducted from this study by multiple regression analysis in clarifying the factors affecting the number of utilization to health center, CE, exposure year and using safety apparatus was significant factor in utilization of health center.; Summary

Serum HBsAg and Anti-HBs Positive Rate among a City Health Center Visitors.: Mal Sook Shin, Tae Yoon Hwang, Chang Yoon Kim; Korean J Prev Med. 1997;30(3):508-517.

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Abstract PDF: Hepatitis B virus(HBV) infection is one of the major health problems in Korea and HBsAg positive rate was known to be about 5~15% in general population. This study was conducted to identify the positive rates of serum HBsAg and anti-HBs among community population regared as having high HBV vaccination rate than in previous decade, using EIA(Enzyme immunoassay) method, in Seo-Gu, Taegu, Korea. The study subjects were 1,160 who visited Seo-Gu Health Center for check-up serologic markers of hepatitis B. The data were obtained from the serologic test for hepatitis markers and questionnaire survey was conducted to obtain the general characteristics, vaccination history, past history of hepatitis and other liver disease , and exposure history to risk factors of hepatitis of the study subjects. The positive rates of HBsAg and anti-HBs were 5.2% and 62.4% respectively. The positive rates of HBsAg for male and female were 6.6% and 4.3% respectively. The age was divided into two groups as group I(less than 15 years old), group II(more than 16years old) according to the hypothesis that these two groups might be different in HBV vaccination rate. HBV vaccination rates for group I and II were 83.1% and 52.3%. The positive rates of HBsAg for group I and II were 2.6% and 6.5%. The positive rates of HBsAg for the vaccinated people of the group I and II were 2.2% and 3.5%, the positive rates of anti-HBs for the vaccinated people of the group I and II were 70.1% and 71.1% respectively. The most significant factor in positive rate of HBsAg was 'hepatitis carrier in family'. Multiple logistic regression analysis revealed that 'hepatitis history' and 'hepatitis carrier in family' were significant variables for positivity of HBsAg, and 'hepatitis B vaccination' was only a significant variable for positivity of anti-HBs.; Summary

Referral Patterns and Needs for Specialist Care among Patient Referred from Health Center.: Tae Yoon Hwang, Chang Yoon Kim, Pock Soo Kang; Korean J Prev Med. 1996;29(1):133-143.

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Abstract PDF: This study was conducted to assess the referral patterns to specialist from general practitioners in health center and perceived needs of referred patients for specialist care in health center. The study subjects were 249 patients who visited to health centers and were referred to other medical facilities. The data were obtained from questionnaire survey which was conducted in Kyongjuu-city Health center, Seongju-Gun Health center and Koryong-Gun Health center in Kyongsangbuk-Do, from June 10 to october 17, 1995. The total referral rate was 2.7%. The proportion of patients who wished to be referred to medical specialists was 85.9%, and the proportion of patients referred by general practitioners in health centers was 14.1%. Among the patients who wished to be referred to medical specialists, 45.9% visited directly to health centers, 34.6% visited health centers via local clinics and 19.5% visited health centers to get referral permission only. The reasons for getting referral permission in health centers were easy geographical accessibility(34.6 %), easy to get referral permission in health centers(27.l%), and very difficult to get referral permission in local clinics(l6.4%). Among the diseases of referred patients, diseases of the musculoskeletal system and connective tissue were most prevalent on a whole, but diseases of nervous system and sensory organs were comparatively high among the patients who wished to be referred to medical specialists and infectious and parasitic diseases were comparatively high among the patients referred by general practitioners in health centers. The most favorable medical facility was general hospital including university hospital in both groups of patients who wished to be referred to medical specialist and the patient referred by general practitioners in health centers. Regarding the needs for specialist care in health center, 75.2% patients who wished to be referred to medical specialists and 74.3% of patients referred by general practitioners in health center wanted the specialist care. The most frequently requested speciality is internal medicine(47.1%), and then orthopedics and general surgery. Based on above results, this study revealed that the majority of patients referred from health center wished to be referred to medical specialists at their own will, so, referral system at health center level should be changed. And if specialist care in health center be provided, the medical care by internist could be provided first, and then that of orthopedics and general surgery could be provided. These kinds of medical cares could be covered by local clinicians as a part-time job on a voluntary basis.; Summary

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