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Original Articles
Who Dies Alone? Demographics, Underlying Diseases, and Healthcare Utilization Patterns of Lonely Death Individuals in Korea
Haibin Bai, Jae-ryun Lee, Min Jung Kang, Young-Ho Jun, Hye Yeon Koo, Jieun Yun, Jee Hoon Sohn, Jin Yong Lee, Hyejin Lee
J Prev Med Public Health. 2025;58(2):218-226.   Published online March 4, 2025
DOI: https://doi.org/10.3961/jpmph.24.704
  • 12,148 View
  • 395 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Lonely death is defined as “a person living in a state of social isolation, disconnected from family, relatives, and others, who dies from suicide, illness, or other causes”. This study investigated the characteristics of individuals who die alone in Korea.
Methods
We constructed a database of lonely death cases by linking data from the Korea Crime Scene Investigation Unit of the Korea National Police Agency with National Health Insurance Service (NHIS) records. A descriptive analysis was performed to evaluate the demographics, underlying diseases, and healthcare utilization patterns among lonely death cases.
Results
Among the 3122 individuals identified as lonely death cases, 2621 (84.0%) were male and 501 (16.0%) were female. The most common age group was 50-59 years (n=930, 29.8%). The NHIS covered 2161 individuals (69.2%), whereas 961 individuals (30.8%) were enrolled in Medical Aid (MA). The highest number of lonely deaths occurred in Seoul areas, with 1468 cases (47.0%). Mood disorders were diagnosed in 1020 individuals (32.7%), and various alcohol-related diseases, including alcoholic liver disease, were also observed. Outpatient visits increased leading up to death but declined in the final 3 months, while hospitalizations decreased and emergency room visits slightly increased.
Conclusions
Most lonely death cases involved male in their 50s, with a disproportionately high number of MA beneficiaries compared to the general population. Many of these individuals also experienced mental health issues or alcohol-related disorders. Preventing social isolation and strengthening social safety nets are critical to reducing the occurrence of lonely deaths.
Summary
Korean summary
한국에서 고독사란 법적으로 “가족, 친척 등 주변 사람들과 단절된 채 사회적 고립상태로 생활하던 사람이 자살ㆍ병사 등으로 임종”하는 것으로 정의하고 있다. 고독사 사망자는 대체적으로 50대 남성이었고, 의료급여 수급권자의 비율이 일반 인구보다 월등히 높았으며, 사망자 대다수는 정신건강 문제 또는 알코올성 질환을 앓고 있었다. 사회적 고립의 예방 및 사회안전망 구축은 고독사 예방에 있어 매우 중요한 역할을 할 것으로 보인다.
Key Message
Lonely death is defined as “a person living in a state of social isolation, disconnected from family, relatives, and others, who dies from suicide, illness, or other causes”. This study investigated the characteristics of individuals who die alone in Korea. Most lonely death cases involved male in their 50s, with a disproportionately high number of MA beneficiaries compared to the general population. Many of these individuals also experienced mental health issues or alcohol-related disorders. Preventing social isolation and strengthening social safety nets are critical to reducing the occurrence of lonely deaths.

Citations

Citations to this article as recorded by  
  • Understanding of solitary death in people living in the community: A scoping review
    Chung Min Cho, Hyeun Jun Moon, Jee-Hye Yoo
    Global Public Health.2025;[Epub]     CrossRef
Healthcare Utilization and Discrepancies by Income Level Among Patients With Newly Diagnosed Type 2 Diabetes in Korea: An Analysis of National Health Insurance Sample Cohort Data
Eun Jee Park, Nam Ju Ji, Chang Hoon You, Weon Young Lee
J Prev Med Public Health. 2024;57(5):471-479.   Published online August 20, 2024
DOI: https://doi.org/10.3961/jpmph.24.165
  • 6,356 View
  • 242 Download
  • 2 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
The use of qualitative healthcare services or its discrepancy between different income levels of the type 2 diabetes (T2D) patients has seldom been studied concurrently. The present study is unique that regarding T2D patients of early stages of diagnosis. Aimed to assess the utilization of qualitative healthcare services and influence of income levels on the inequality of care among newly diagnosed patients with T2D.
Methods
A retrospective cohort study of 7590 patients was conducted by the National Health Insurance Service National Sample Cohort 2.0 from 2002 to 2015. Insured employee in 2013 with no history of T2D between 2002 and 2012 were included. The standard of diabetes care includes hemoglobin A1c (HbAlc; 4 times/y), eyes (once/y) and lipid abnormalities (once/y). Multivariate logistic regression analysis was performed to examine the difference between income levels and inequality of care.
Results
From years 1 to 3, rates of appropriate screening fell from 16.9% to 14.1% (HbA1c), 15.8% to 14.5% (eye), and 59.2% to 33.2% (lipid abnormalities). Relative to income class 5 (the highest-income group), HbA1 screening was significantly less common in class 2 (year 2: odds ratio [OR], 0.78; 95% confidence interval [CI], 0.61 to 0.99; year 3: OR, 0.79; 95% CI, 0.69 to 0.91). In year 1, lipid screening was less common in class 1 (OR, 0.84; 95% CI, 0.73 to 0.98) than in class 5, a trend that continued in year 2. Eye screening rates were consistently lower in class 1 than in class 5 (year 1: OR, 0.73; 95% CI, 0.60 to 0.89; year 2: OR, 0.63; 95% CI, 0.50 to 0.78; year 3: OR, 0.81; 95% CI, 0.67 to 0.99).
Conclusions
Newly diagnosed T2D patients have shown low rate of HbA1c and screening for diabetic-related complications and experienced inequality in relation to receiving qualitative diabetes care by income levels.
Summary
Korean summary
의료서비스 이용의 강도와 질을 측정하는 당뇨 관련 합병증 검진율은 저소득층에서 특히 낮았습니다. 보편적 건강 보장이 있는 국가에서도 신환환자 특히 낮은 경제적 계층의 치료 불균형을 해소 하기 위해서는 재정적 부담은 절감하고, 건강 문해력 증진시키고, 일차의료 기관의 기능을 최적화 하여 책임을 강화하는 것이 필요합니다.
Key Message
Diabetic-related complications screening rates that measure the intensity and quality of medical care service usage were statistically lower in low-income groups. Reducing financial burden, promoting health literacy and optimizing the function of primary care physician and reinforcing the health care provider’s accountability are necessary to address the discrepancy of care for those with low socioeconomic status people in early stage of disease, even in nations with universal health coverage.

Citations

Citations to this article as recorded by  
  • Older Adults with Diabetes in Korea: Latest Clinical and Epidemiologic Trends
    Kyuho Kim, Bongseong Kim, Kyuna Lee, Yu-Bae Ahn, Seung-Hyun Ko, Sung Hee Choi, Kyungdo Han, Jae-Seung Yun
    Diabetes & Metabolism Journal.2025; 49(2): 183.     CrossRef
Perspective
The Paradox of the Ugandan Health Insurance System: Challenges and Opportunities for Health Reform
Emmanuel Otieno, Josephine Namyalo
J Prev Med Public Health. 2024;57(1):91-94.   Published online December 30, 2023
DOI: https://doi.org/10.3961/jpmph.23.110
  • 5,429 View
  • 348 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDF
For nearly four decades, Ugandans have experienced a period marked by hope, conflict, and resilience across various aspects of healthcare reform. The health insurance system in Uganda lacks a legal framework and does not extend benefits to the entire population. In Uganda, community-based health insurance is common among those in the informal sector, while private medical insurance is typically provided to employees by their workplaces and agencies. The National Health Insurance Scheme Bill, introduced in 2019, was passed in 2021. If the President of Uganda gives his assent to the National Health Insurance Bill, it will become a significant policy driving health and universal health coverage. However, this bill is not without its shortcomings. In this perspective, we aim to explore the complex interplay of challenges and opportunities facing Uganda’s health sector.
Summary
Key Message
For the Ugandans, nearly the last four decades have been years of hope, conflict, and resilience in a myriad of contexts for healthcare reform. Health insurance system has no legal framework and provides benefits not to the entire national population. The 2019 National Health Insurance scheme Bill was passed in 2021. If the President of Uganda assents to the National Health Insurance Bill, it will be a compelling policy in health and health for all policies. But this Bill has several drawbacks. In this perspective, we aimed to provide intricacies and mix of challenges and opportunities for the health sector.

Citations

Citations to this article as recorded by  
  • Regulation of artificial intelligence in Uganda’s healthcare: exploring an appropriate regulatory approach and framework to deliver universal health coverage
    Kalule Grancia Mugalula
    International Journal for Equity in Health.2025;[Epub]     CrossRef
  • Desafíos éticos en los modelos de seguro de salud de Uganda: abordando dilemas para mejorar la equidad, el acceso y la sostenibilidad
    Bernard Rabwoni
    Medicina y Ética.2025; 36(3): 858.     CrossRef
  • Economic assessment of potential changes to essential medicines for diabetes in Uganda
    Atousa Bonyani, Tracy K. Lin, Ambrose Jakira, Isaac D. Kimera, Martin Muddu, Jeremy I. Schwartz, James G. Kahn, Sonak D. Pastakia
    PLOS One.2025; 20(6): e0326806.     CrossRef
  • Emergency Obstetric Care Access Dynamics in Kampala City, Uganda: Analysis of Women’s Self-Reported Care-Seeking Pathways
    Catherine Birabwa, Lenka Beňová, Josefien van Olmen, Aline Semaan, Peter Waiswa, Aduragbemi Banke-Thomas
    Global Health: Science and Practice.2024; 12(6): e2400242.     CrossRef
Systematic Review
Adjusting for Confounders in Outcome Studies Using the Korea National Health Insurance Claim Database: A Review of Methods and Applications
Seung Jin Han, Kyoung Hoon Kim
J Prev Med Public Health. 2024;57(1):1-7.   Published online November 16, 2023
DOI: https://doi.org/10.3961/jpmph.23.250
  • 7,136 View
  • 512 Download
  • 7 Web of Science
  • 7 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
Adjusting for potential confounders is crucial for producing valuable evidence in outcome studies. Although numerous studies have been published using the Korea National Health Insurance Claim Database, no study has critically reviewed the methods used to adjust for confounders. This study aimed to review these studies and suggest methods and applications to adjust for confounders.
Methods
We conducted a literature search of electronic databases, including PubMed and Embase, from January 1, 2021 to December 31, 2022. In total, 278 studies were retrieved. Eligibility criteria were published in English and outcome studies. A literature search and article screening were independently performed by 2 authors and finally, 173 of 278 studies were included.
Results
Thirty-nine studies used matching at the study design stage, and 171 adjusted for confounders using regression analysis or propensity scores at the analysis stage. Of these, 125 conducted regression analyses based on the study questions. Propensity score matching was the most common method involving propensity scores. A total of 171 studies included age and/or sex as confounders. Comorbidities and healthcare utilization, including medications and procedures, were used as confounders in 146 and 82 studies, respectively.
Conclusions
This is the first review to address the methods and applications used to adjust for confounders in recently published studies. Our results indicate that all studies adjusted for confounders with appropriate study designs and statistical methodologies; however, a thorough understanding and careful application of confounding variables are required to avoid erroneous results.
Summary
Korean summary
건강보험청구자료를 사용한 성과연구에서는 교란요인 통제가 중요하다. 최근 발표된 연구들은 연구설계와 통계 분석 과정에 적절하게 교란요인을 통제하였다. 연구의 질을 높이기 위해서는 건강보험청구자료에서 수집 가능한 교란 요인에 대한 이해와 방법론적 가이드라인이 요구된다.
Key Message
All recently published studies using Health Insurance Claims Database adjusted for confounders with appropriate study designs and statistical methodologies. The review suggests the need for careful application of confounding variables and the methodological guidance to improve the quality of outcome studies.

Citations

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  • Factors Associated With Receiving Early Post-Discharge Follow-up Care in Patients With Schizophrenia
    Song Ee Che, Kyoung-Hoon Kim
    Journal of Korean Medical Science.2025;[Epub]     CrossRef
  • The Diabetogenic Effect of Statin Use May Interact With Polygenic Risk Scores for Type 2 Diabetes: Evidence From the UK Biobank
    Jong Hyun Park, Kyu-Taek Lim, Jooyeon Lee, Yongjin Gil, Joohon Sung
    Journal of Preventive Medicine and Public Health.2025; 58(1): 92.     CrossRef
  • Validation of Diagnostic Code Definitions for Identifying Patient in Korean Health Insurance Claims Data: A Scoping Review
    Kyoung-Hoon Kim
    Journal of Korean Medical Science.2025;[Epub]     CrossRef
  • Worsening of health disparities across COVID-19 pandemic stages in Korea
    Hyejin Lee, Hyunwoo Nam, Jae-ryun Lee, Hyemin Jung, Jin Yong Lee
    Epidemiology and Health.2024; 46: e2024038.     CrossRef
  • Trends in Regional Disparities in Cardiovascular Surgery and Mortality in Korea: A National Cross-sectional Study
    Dal-Lae Jin, Kyoung-Hoon Kim, Euy Suk Chung, Seok-Jun Yoon
    Journal of Preventive Medicine and Public Health.2024; 57(3): 260.     CrossRef
  • Low household income increases risks for chronic obstructive pulmonary disease in young population: a nationwide retrospective cohort study in South Korea
    Chiwook Chung, Kyu Na Lee, Dong Wook Shin, Sei Won Lee, Kyungdo Han
    BMJ Open Respiratory Research.2024; 11(1): e002444.     CrossRef
  • An epidemic of cataract surgery in Korea: the effects of private health insurance on the National Health Insurance Service
    Hyejin Lee, Soo-Hee Hwang, Choon-Seon Park, Seol-Hee Chung, Catherine L. Chen, Jin Yong Lee, Jin Soo Lee
    Epidemiology and Health.2024; 46: e2024015.     CrossRef
Original Article
Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study
Yeong Geun Gwon, Seung Jin Han, Kyoung Hoon Kim
J Prev Med Public Health. 2023;56(3):248-254.   Published online April 12, 2023
DOI: https://doi.org/10.3961/jpmph.23.015
  • 6,322 View
  • 128 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care.
Methods
Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients’ characteristics over time, and significant changes in the rates were identified by joinpoint regression.
Results
The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic.
Conclusions
The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.
Summary
Korean summary
본 연구에서는 급성심근경색증과 뇌졸중 치명률, 외래진료 민감질환의 예방 가능한 입원율을 사용하여 한국의 의료 질 수준을 분석하였다. 2008~2020년 동안 치명률과 예방 가능한 입원율은 감소하는 추세이다. 그러나, 예방 가능한 입원율은 다른 국가에 비해 상대적으로 높아 환자의 건강결과 향상을 위하여 일차의료 강화가 요구된다.

Citations

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  • National Expenditures on Anticancer and Immunomodulating Agents During 2013–2022 in Korea
    Jieun Yun, Youngs Chang, Minsol Jo, Yerin Heo, Dong-Sook Kim
    Journal of Korean Medical Science.2025;[Epub]     CrossRef
  • Evidence of Overlapping Roles Between Clinics and Hospitals in Primary Care
    Boram Sim, Jihye Shin, Hyun Woo Kim, Jin Yong Lee, Min-Woo Jo
    Journal of Korean Medical Science.2025;[Epub]     CrossRef
  • Impacto da COVID-19 na Atenção Primária à Saúde e suas Condições Sensíveis: Revisão de Escopo
    Vinicius Paim Brasil, Juliana Prestes Ferigollo, Felipa Amadigi, Fúlvio Borges Nedel
    Saúde Coletiva (Barueri).2025; 16(101): 17732.     CrossRef
  • Mortality and Disparities of Acute Myocardial Infarction and Stroke in Korea, 2008–2019
    Ji-Sook Choi, Soomin Kim, Choon-Seon Park, Hyejin Lee, Jin Yong Lee, Sun Min Kim
    Yonsei Medical Journal.2024; 65(9): 534.     CrossRef
COVID-19: Special Article
COVID-19 International Collaborative Research by the Health Insurance Review and Assessment Service Using Its Nationwide Real-world Data: Database, Outcomes, and Implications
Yeunsook Rho, Do Yeon Cho, Yejin Son, Yu Jin Lee, Ji Woo Kim, Hye Jin Lee, Seng Chan You, Rae Woong Park, Jin Yong Lee
J Prev Med Public Health. 2021;54(1):8-16.   Published online January 26, 2021
DOI: https://doi.org/10.3961/jpmph.20.616
  • 8,809 View
  • 218 Download
  • 11 Web of Science
  • 10 Crossref
AbstractAbstract PDF
This article aims to introduce the inception and operation of the COVID-19 International Collaborative Research Project, the world’s first coronavirus disease 2019 (COVID-19) open data project for research, along with its dataset and research method, and to discuss relevant considerations for collaborative research using nationwide real-world data (RWD). COVID-19 has spread across the world since early 2020, becoming a serious global health threat to life, safety, and social and economic activities. However, insufficient RWD from patients was available to help clinicians efficiently diagnose and treat patients with COVID-19, or to provide necessary information to the government for policy-making. Countries that saw a rapid surge of infections had to focus on leveraging medical professionals to treat patients, and the circumstances made it even more difficult to promptly use COVID-19 RWD. Against this backdrop, the Health Insurance Review and Assessment Service (HIRA) of Korea decided to open its COVID-19 RWD collected through Korea’s universal health insurance program, under the title of the COVID-19 International Collaborative Research Project. The dataset, consisting of 476 508 claim statements from 234 427 patients (7590 confirmed cases) and 18 691 318 claim statements of the same patients for the previous 3 years, was established and hosted on HIRA’s in-house server. Researchers who applied to participate in the project uploaded analysis code on the platform prepared by HIRA, and HIRA conducted the analysis and provided outcome values. As of November 2020, analyses have been completed for 129 research projects, which have been published or are in the process of being published in prestigious journals.
Summary

Citations

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  • Trends in surgery and anesthesia practices during the COVID-19 pandemic: a nationwide analysis from South Korea’s Health Insurance Database
    EunJin Ahn, Hyo Jin Kim, Si Ra Bang
    Frontiers in Medicine.2025;[Epub]     CrossRef
  • Symptoms and Conditions in Children and Adults up to 90 Days after SARS-CoV-2 Infection: A Retrospective Observational Study Utilizing the Common Data Model
    Minjung Han, Taehee Chang, Hae-ryoung Chun, Suyoung Jo, Yeongchang Jo, Dong Han Yu, Sooyoung Yoo, Sung-il Cho
    Journal of Clinical Medicine.2024; 13(10): 2911.     CrossRef
  • Data Resource Profile: Health Insurance Review and Assessment Service Covid-19 Observational Medical Outcomes Partnership (HIRA Covid-19 OMOP) database in South Korea
    Chungsoo Kim, Dong Han Yu, Hyeran Baek, Jaehyeong Cho, Seng Chan You, Rae Woong Park
    International Journal of Epidemiology.2024;[Epub]     CrossRef
  • Effect of changes in the hearing aid subsidy on the prevalence of hearing loss in South Korea
    Chul Young Yoon, Junhun Lee, Tae Hoon Kong, Young Joon Seo
    Frontiers in Neurology.2023;[Epub]     CrossRef
  • Scalable Infrastructure Supporting Reproducible Nationwide Healthcare Data Analysis toward FAIR Stewardship
    Ji-Woo Kim, Chungsoo Kim, Kyoung-Hoon Kim, Yujin Lee, Dong Han Yu, Jeongwon Yun, Hyeran Baek, Rae Woong Park, Seng Chan You
    Scientific Data.2023;[Epub]     CrossRef
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    BMC Pharmacology and Toxicology.2022;[Epub]     CrossRef
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    Youngsik Hwang, Dasom Kim, Sukhyun Ryu
    Preventive Medicine Reports.2022; 26: 101728.     CrossRef
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    Albert Prats-Uribe, Anthony G Sena, Lana Yin Hui Lai, Waheed-Ul-Rahman Ahmed, Heba Alghoul, Osaid Alser, Thamir M Alshammari, Carlos Areia, William Carter, Paula Casajust, Dalia Dawoud, Asieh Golozar, Jitendra Jonnagaddala, Paras P Mehta, Mengchun Gong, D
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Perspective
Dilemmas Within the Korean Health Insurance System
Donghwi Park, Min Cheol Chang
J Prev Med Public Health. 2020;53(4):285-288.   Published online July 1, 2020
DOI: https://doi.org/10.3961/jpmph.20.074
  • 8,141 View
  • 132 Download
  • 6 Crossref
AbstractAbstract PDF
The health insurance system in Korea is well-established and provides benefits for the entire national population. In Korea, when patients are treated at a hospital, the hospital receives a partial payment for the treatment from the patient, and the remaining amount is provided by the health insurance service. The Health Insurance Review and Assessment Service (HIRA) assesses whether the treatment was appropriate. If HIRA deems the treatment appropriate, the doctor can receive payment from the health insurance service. However, this system has several drawbacks. In this study, we aimed to provide examples of the problems that can occur in relation to HIRA assessments in Korea through actual clinical cases.
Summary

Citations

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  • Healthcare affordability and breast cancer screening uptake: an ecological analysis
    Jingmei Li, Serene Si Ning Goh, Mikael Hartman
    Discover Public Health.2025;[Epub]     CrossRef
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    Emmanuel Otieno, Josephine Namyalo
    Journal of Preventive Medicine and Public Health.2024; 57(1): 91.     CrossRef
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    Soojin Lee, Gayeon Kang, Seunghwan Song, Kwangha Lee, Wanho Yoo, Hyojin Jang, Myung Hun Jang
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    Min Cheol Chang, Mathieu Boudier-Revéret
    Journal of Yeungnam Medical Science.2024; 42: 16.     CrossRef
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    Seungmin Jeong, So Yeon Kong, Seung-sik Hwang, Sung-il Cho
    Journal of Health Informatics and Statistics.2022; 47(4): 268.     CrossRef
  • Diagnosis of Duchenne Muscular Dystrophy in a Presymptomatic Infant Using Next-Generation Sequencing and Chromosomal Microarray Analysis: A Case Report
    Eun-Woo Park, Ye-Jee Shim, Jung-Sook Ha, Jin-Hong Shin, Soyoung Lee, Jang-Hyuk Cho
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Original Articles
Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017
Akram Hernández-Vásquez, Carlos Rojas-Roque, Rodrigo Vargas-Fernández, Diego Rosselli
J Prev Med Public Health. 2020;53(4):266-274.   Published online June 10, 2020
DOI: https://doi.org/10.3961/jpmph.20.035
  • 10,447 View
  • 214 Download
  • 10 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017.
Methods
We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index.
Results
The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05).
Conclusions
Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.
Summary

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Prescription of Systemic Steroids for Acute Respiratory Infections in Korean Outpatient Settings: Overall Patterns and Effects of the Prescription Appropriateness Evaluation Policy
Taejae Kim, Young Kyung Do
J Prev Med Public Health. 2020;53(2):82-88.   Published online November 18, 2019
DOI: https://doi.org/10.3961/jpmph.19.090
  • 13,660 View
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AbstractAbstract AbstractSummary PDF
Objectives
The objective of this study was to identify individual and institutional factors associated with the prescription of systemic steroids in patients with acute respiratory infections and to investigate the role of a policy measure aimed to reduce inappropriate prescriptions. Methods: We used data from the National Health Insurance Service-National Sample Cohort from 2006 to 2015 and focused on episodes of acute respiratory infection. Descriptive analysis and multiple logistic regression analysis were performed to identify individual-level and institution-level factors associated with the prescription of systemic steroids. In addition, steroid prescription rates were compared with antibiotic prescription rates to assess their serial trends in relation to Health Insurance Review and Assessment Service (HIRA) Prescription Appropriateness Evaluation policy. Results: Among a total of 9 460 552 episodes of respiratory infection, the steroid prescription rate was 6.8%. Defined daily doses/1000 persons/d of steroid increased gradually until 2009, but rose sharply since 2010. The steroid prescription rate was higher among ear, nose and throat specialties (13.0%) than other specialties, and in hospitals (8.0%) than in tertiary hospitals (3.0%) and other types of institutions. Following a prolonged reduction in the steroid prescription rate, this rate increased since the HIRA Prescription Appropriateness Evaluation dropped steroids from its list of evaluation items in 2009. Such a trend reversal was not observed for the prescription rate of antibiotics, which continue to be on the HIRA Prescription Appropriateness Evaluation list. Conclusions: Specialty and type of institution are important correlates of steroid prescriptions in cases of acute respiratory infection. Steroid prescriptions can also be influenced by policy measures, such as the HIRA Prescription Appropriateness Evaluation policy.
Summary
Korean summary
이 연구에서는 요양급여 청구자료를 기준으로 급성 상기도 감염에서 스테로이드를 처방하는 경우와 관련하여 다음과 같은 특징을 확인하였다. 첫째, 환자 특성과 기관 특성을 모두 고려하였을 때 진료과목과 기관의 종별 구분에서 감기 스테로이드 처방률은 상당한 변이를 보였다. 둘째, 약제급여적정성평가 항목에서 스테로이드가 제외된 직후 처방률이 시계열적으로 상승하였으며, 이는 처방 행태에 정책 요인이 중요한 영향을 미칠 수 있음을 뜻한다.

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    Xiaoyi Li, Zhen Zeng, Xingying Fan, Wenju Wang, Xiaobo Luo, Junli Yang, Yue Chang
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    Qiong Yang, Fangfang Yuan, Li Li, Jianfeng Jin, Junhong He
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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
  • 15,361 View
  • 179 Download
  • 6 Crossref
AbstractAbstract PDF
Objectives
To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups.
Methods
This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics.
Results
The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients.
Conclusions
The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.
Summary

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  • Cancer care patterns in South Korea: Types of hospital where patients receive care and outcomes using national health insurance claims data
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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
  • 11,090 View
  • 198 Download
  • 6 Crossref
AbstractAbstract 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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Enrollment in Private Medical Insurance and Utilization of Medical Services Among Children and Adolescents: Data From the 2009-2012 Korea Health Panel Surveys
Dong Hee Ryu, Sin Kam, Young-Taek Doo
J Prev Med Public Health. 2016;49(2):118-128.   Published online March 24, 2016
DOI: https://doi.org/10.3961/jpmph.16.003
  • 13,708 View
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  • 3 Crossref
AbstractAbstract PDF
Objectives
The purposes of this study were to examine the status of children and adolescents with regard to enrollment in private medical insurance (PMI) and to investigate its influence on their utilization of medical services.
Methods
The present study assessed 2973 subjects younger than 19 years of age who participated in five consecutive Korea Health Panel surveys from 2009 to 2012.
Results
At the initial assessment, less than 20% of the study population had not enrolled in any PMI program, but this proportion decreased over time. Additionally, the number of subjects with more than two policies increased, the proportions of holders of indemnity-type only (‘I’-only) and of fixed amount+indemnity-type (‘F+I’) increased, whereas the proportion of holders with fixed amount-type only (‘F’-only) decreased. Compared with subjects without private insurance, PMI policyholders were more likely to use outpatient and emergency services, and the number of policies was proportionately related to inpatient service utilization. Regarding out-patient care, subjects with ‘F’-only PMI used these services more often than did uninsured subjects (odds ratio [OR], 1.69), whereas subjects with ‘I’-only PMI or ‘F+I’ PMI utilized a broad range of inpatient, outpatient, and emergency services relative to uninsured subjects (ORs for ‘I’-only: 1.39, 1.63, and 1.38, respectively; ORs for ‘F+I’: 1.67, 2.09, and 1.37, respectively).
Conclusions
The findings suggest public policy approaches to standardizing PMI contracts, reform in calculation of premiums in PMI, re-examination regarding indemnity insurance products, and mutual control mechanisms to mediate between national health insurance services and private insurers are required.
Summary

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  • Medical insurance coverage and its associated factors among children in urban and rural Chongqing, China
    Caihui Hu, Jingyu Chen, Lanling Chen, Xinyuan Yao, Shunqing Luo, Xiaoping Jiang, Lan Chen, Fengming Wang, Jie Li, Jian Liu, Shihai Zheng, Xiaohua Liang
    International Health.2025;[Epub]     CrossRef
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    Dong-Hee Ryu, Yong-jun Choi, Jeehye Lee
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  • Community-Based Health Insurance Increased Health Care Utilization and Reduced Mortality in Children Under-5, Around Bwindi Community Hospital, Uganda Between 2015 and 2017
    Nahabwe Haven, Andrew E. Dobson, Kuule Yusuf, Scott Kellermann, Birungi Mutahunga, Alex G. Stewart, Ewan Wilkinson
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Factors Affecting the Downward Mobility of Psychiatric Patients: A Korean Study of National Health Insurance Beneficiaries
Un-Na Kim, Yeon-Yong Kim, Jin-Seok Lee
J Prev Med Public Health. 2016;49(1):53-60.   Published online December 22, 2015
DOI: https://doi.org/10.3961/jpmph.15.052
  • 11,266 View
  • 105 Download
  • 12 Crossref
AbstractAbstract PDF
Objectives
The purpose of this study is to examine the magnitude of and the factors associated with the downward mobility of first-episode psychiatric patients.
Methods
This study used the claims data from the Korean Health Insurance Review and Assessment Service. The study population included 19 293 first-episode psychiatric inpatients diagnosed with alcohol use disorder (International Classification of Diseases, 10th revision [ICD-10] code F10), schizophrenia and related disorders (ICD-10 codes F20-F29), and mood disorders (ICD-10 codes F30-F33) in the first half of 2005. This study included only National Health Insurance beneficiaries in 2005. The dependent variable was the occurrence of downward mobility, which was defined as a health insurance status change from National Health Insurance to Medical Aid. Logistic regression analysis was used to assess factors associated with downward drift of first-episode psychiatric patients.
Results
About 10% of the study population who were National Health Insurance beneficiaries in 2005 became Medical Aid recipients in 2007. The logistic regression analysis showed that age, gender, primary diagnosis, type of hospital at first admission, regular use of outpatient clinic, and long-term hospitalization are significant predictors in determining downward drift in newly diagnosed psychiatric patients.
Conclusions
This research showed that the downward mobility of psychiatric patients is affected by long-term hospitalization and medical care utilization. The findings suggest that early intensive intervention might reduce long-term hospitalization and the downward mobility of psychiatric patients.
Summary

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Factors Determining Children’s Private Health Insurance Enrolment and Healthcare Utilization Patterns: Evidence From the 2008 to 2011 Health Panel Data
Jawoon Shin, Tae-Jin Lee, Sung-il Cho, Seung Ah Choe
J Prev Med Public Health. 2015;48(6):319-329.   Published online November 16, 2015
DOI: https://doi.org/10.3961/jpmph.15.057
  • 12,433 View
  • 106 Download
  • 4 Crossref
AbstractAbstract PDF
Objectives
Parental socioeconomic status (SES) exerts a substantial influence on children’s health. The purpose of this study was to examine factors determining children’s private health insurance (PHI) enrolment and children’s healthcare utilization according to PHI coverage.
Methods
Korea Health Panel data from 2011 (n=3085) was used to explore the factors determining PHI enrolment in children younger than 15 years of age. A logit model contained health status and SES variables for both children and parents. A fixed effects model identified factors influencing healthcare utilization in children aged 10 years or younger, using 2008 to 2011 panel data (n=9084).
Results
The factors determining children’s PHI enrolment included children’s age and sex and parents’ educational status, employment status, and household income quintile. PHI exerted a significant effect on outpatient cost, inpatient cost, and number of admissions. Number of outpatient visits and total length of stay were not affected by PHI status. The interaction between PHI and age group increased outpatient cost significantly.
Conclusions
Children’s PHI enrolment was influenced by parents’ SES, while healthcare utilization was affected by health and disability status. Therefore, the results of this study suggest disparities in healthcare utilization according to PHI enrollment.
Summary

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    Mohd Adli Abd Khalim, Surianti Sukeri, Gopal Ashish Sharma
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  • Equity in the public social healthcare protection in Tanzania: does it matter on household healthcare financing?
    Felician Andrew Kitole, Robert Michael Lihawa, Eliaza Mkuna
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  • Does health insurance solve health care utilization puzzle in Tanzania?
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  • Enrollment in Private Medical Insurance and Utilization of Medical Services Among Children and Adolescents: Data From the 2009-2012 Korea Health Panel Surveys
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    Journal of Preventive Medicine and Public Health.2016; 49(2): 118.     CrossRef
The Socioeconomic Burden of Coronary Heart Disease in Korea
Hoo-Sun Chang, Han-Joong Kim, Chung-Mo Nam, Seung-Ji Lim, Young-Hwa Jang, Sera Kim, Hye-Young Kang
J Prev Med Public Health. 2012;45(5):291-300.   Published online September 28, 2012
DOI: https://doi.org/10.3961/jpmph.2012.45.5.291
  • 17,009 View
  • 124 Download
  • 33 Crossref
AbstractAbstract PDF
Objectives

We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data.

Methods

A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective.

Results

Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183, which is about 2 times higher than the cost for angina ($1556).

Conclusions

The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.

Summary

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Special Article
Designing an Effective Pay-for-performance System in the Korean National Health Insurance
Hyoung-Sun Jeong
J Prev Med Public Health. 2012;45(3):127-136.   Published online May 31, 2012
DOI: https://doi.org/10.3961/jpmph.2012.45.3.127
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AbstractAbstract PDF

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

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    Hongsoo Kim, Shou-Hsia Cheng
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  • Impact of health insurance status changes on healthcare utilisation patterns: a longitudinal cohort study in South Korea
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  • Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries
    Ricarda Milstein, Jonas Schreyoegg
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Review
Prevention in the United States Affordable Care Act.
Charles M Preston, Miriam Alexander
J Prev Med Public Health. 2010;43(6):455-458.
DOI: https://doi.org/10.3961/jpmph.2010.43.6.455
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AbstractAbstract PDF
The Affordable Care Act (ACA) was signed into law on March 23, 2010 and will fundamentally alter health care in the United States for years to come. The US is currently one of the only industrialized countries without universal health insurance. The new law expands existing public insurance for the poor. It also provides financial credits to low income individuals and some small businesses to purchase health insurance. By government estimates, the law will bring insurance to 30 million people. The law also provides for a significant new investment in prevention and wellness. It appropriates an unprecedented $15 billion in a prevention and public health fund, to be disbursed over 10 years, as well as creates a national prevention council to oversee the government's prevention efforts. This paper discusses 3 major prevention provisions in the legislation: 1) the waiving of cost-sharing for clinical preventive services, 2) new funding for community preventive services, and 3) new funding for workplace wellness programs. The paper examines the scientific evidence behind these provisions as well as provides examples of some model programs. Taken together, these provisions represent a significant advancement for prevention in the US health care system, including a shift towards healthier environments. However, in this turbulent economic and political environment, there is a real threat that much of the law, including the prevention provisions, will not receive adequate funding.
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English Abstract
Impact of Health Insurance Type on the Quality of Hemodialysis Services: A Multilevel Analysis.
Jin Hee Jung, Soon Man Kwon, Kyoung Hoon Kim, Seon Kyoung Lee, Dong Sook Kim
J Prev Med Public Health. 2010;43(3):245-256.
DOI: https://doi.org/10.3961/jpmph.2010.43.3.245
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AbstractAbstract PDF
OBJECTIVES
This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid. METHODS: This study used data from sampled hospitals that provided a hemodialysis service. A total of 2287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time, erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as: hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best). RESULTS: There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI=0.43-0.99). However, frequency of hemodialysis, hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb> or =11 g/dL, blood pressure within the range of 100-140/60-90 mmHg, calcium x phosphate< or =55 g2/dL2 and albumin> or =4 g/dL were not significantly different between the groups. CONCLUSIONS: There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis.
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  • A comparative study of epidemiological characteristics, treatment outcomes, and mortality among patients undergoing hemodialysis by health insurance types: data from the Korean Renal Data System
    Kyeong Min Kim, Soyoung Lee, Jong Ho Shin, Mira Park
    Kidney Research and Clinical Practice.2025; 44(1): 164.     CrossRef
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    Ji Hye Lee, Tae-Young Heo
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    Young Eun Choi, Kang Suk Lee
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  • Factors Affecting Diabetic Screening Behavior of Korean Adults: A Multilevel Analysis
    Hyeongsu Kim, Minjung Lee, Haejoon Kim, Kunsei Lee, Sounghoon Chang, Vitna Kim, Jun Pyo Myong, Soyoun Jeon
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Evaluation Studies
An Evaluation of Sampling Design for Estimating an Epidemiologic Volume of Diabetes and for Assessing Present Status of Its Control in Korea.
Ji Sung Lee, Jaiyong Kim, Sei Hyun Baik, Ie Byung Park, Juneyoung Lee
J Prev Med Public Health. 2009;42(2):135-142.
DOI: https://doi.org/10.3961/jpmph.2009.42.2.135
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AbstractAbstract PDF
OBJECTIVES
An appropriate sampling strategy for estimating an epidemiologic volume of diabetes has been evaluated through a simulation. METHODS: We analyzed about 250 million medical insurance claims data submitted to the Health Insurance Review & Assessment Service with diabetes as principal or subsequent diagnoses, more than or equal to once per year, in 2003. The database was re-constructed to a 'patient-hospital profile' that had 3,676,164 cases, and then to a 'patient profile' that consisted of 2,412,082 observations. The patient profile data was then used to test the validity of a proposed sampling frame and methods of sampling to develop diabetic-related epidemiologic indices. RESULTS: Simulation study showed that a use of a stratified two-stage cluster sampling design with a total sample size of 4,000 will provide an estimate of 57.04% (95% prediction range, 49.83 - 64.24%) for a treatment prescription rate of diabetes. The proposed sampling design consists, at first, stratifying the area of the nation into "metropolitan/city/county" and the types of hospital into "tertiary/secondary/primary/clinic" with a proportion of 5:10:10:75. Hospitals were then randomly selected within the strata as a primary sampling unit, followed by a random selection of patients within the hospitals as a secondly sampling unit. The difference between the estimate and the parameter value was projected to be less than 0.3%. CONCLUSIONS: The sampling scheme proposed will be applied to a subsequent nationwide field survey not only for estimating the epidemiologic volume of diabetes but also for assessing the present status of nationwide diabetes control.
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  • Diabetes Epidemics in Korea: Reappraise Nationwide Survey of Diabetes "Diabetes in Korea 2007"
    Ie Byung Park, Jaiyong Kim, Dae Jung Kim, Choon Hee Chung, Jee-Young Oh, Seok Won Park, Juneyoung Lee, Kyung Mook Choi, Kyung Wan Min, Jeong Hyun Park, Hyun Shik Son, Chul Woo Ahn, Hwayoung Kim, Sunhee Lee, Im Bong Lee, Injeoung Choi, Sei Hyun Baik
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English Abstracts
The Effect of the Cost Exemption Policy for Hospitalized Children under 6 Years Old on the Medical Utilization in Korea.
Kyeong Su Jeon, Seok Jun Yoon, Hyeong Sik Ahn, Hyun Woong Shin, Young Hye Yoon, Se Min Hwang, Min Ho Kyung
J Prev Med Public Health. 2008;41(5):295-299.
DOI: https://doi.org/10.3961/jpmph.2008.41.5.295
  • 6,052 View
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AbstractAbstract PDF
OBJECTIVES
The Korean government in January 2006 instigated an exemption policy for hospitalized children under the age of six years old. This study examines how this policy affected the utilization of medical care in Korea. METHODS: A total of 1,513,797 claim records from the Health Insurance Review Agency were analyzed by complete enumeration methods. The changes of medical utilization were compared from 2005 to 2006. In addition, the changes of medical utilization between 2004 and 2005 were compared as a pseudocontrol group. RESULTS: The admission rate increased 1.14-fold from 15.20% in 2004 to 17.32% in 2005, and this further increased 1.08-fold to 18.65% in 2006. The increase of patients with a common cold (1.2-fold) was higher than that of both the general patients (1.08-fold) and the patients with the top 10 fatal diseases (0.91-fold). The average length of stay per case for clinics showed the highest increase rates (1.06-fold). The rates of patients with the common cold showed a higher increase (1.05-fold) than that of the general patients. The average medical expense per case was increased by 1.10-fold from 2005 to 2006, which was higher than that from 2004 to 2005 (1.04-fold). The increase rate for patients with the common cold was higher at 1.18-fold than that of the general patients. CONCLUSIONS: The cost exemption policy has especially led to an increase in the utilization of clinics and the utilization by patients with a common cold.
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    Minah Park, Eun-Cheol Park, Hongin Noh, Sung-In Jang
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
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    Sung-Hoon Park, Sang Gyu Kwak, Ji Yoon Kim
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    Jinha An, Sukil Kim
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Estimating the Economic Burden of Osteoporotic Vertebral Fracture among Elderly Korean Women.
Hye Young Kang, Dae Ryong Kang, Young Hwa Jang, Sung Eun Park, Won Jung Choi, Seong Hwan Moon, Kyu Hyun Yang
J Prev Med Public Health. 2008;41(5):287-294.
DOI: https://doi.org/10.3961/jpmph.2008.41.5.287
  • 6,577 View
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AbstractAbstract PDF
OBJECTIVES
To estimate the economic burden of osteoporotic vertebral fracture (VF) from a societal perspective. METHODS: From 2002 to 2004, we identified all National Health Insurance claims records for women > or = 50 years old with a diagnosis of VF. The first 6-months was defined as a "clearance period," Ysuch that patients were considered as incident cases if their first claim of fracture was recorded after June 30, 2002. We only included patients with > or = one claim of a diagnosis of, or prescription for, osteoporosis over 3 years. For each patient, we cumulated the claims amount for the first visit and for the follow-up treatments for 1 year. The hospital charge data from 4 hospitals were investigated to measure the proportion of the non-covered services. Face-to-face interviews were conducted with 106 patients from the 4 study sites to measure the out-of-pocket spending outside of hospitals. RESULTS: During 2.5 years, 131,453 VF patients were identified. The patients had an average of 3.38 visits, 0.40 admissions and 6.36 inpatient days. The per capita cost was 1,909,690 Won: 71.5% for direct medical costs, 20.6% for direct non-medical costs and 7.9% for indirect costs. The per capita cost increased with increasing age: 1,848,078 Won for those aged 50-64, 2,084,846 Won for 65-74, 2,129,530 Won for 75-84and 2,121,492 Won for those above 84. CONCLUSIONS: Exploring the economic burden of osteoporotic VF is expected to motivate to adopt effective treatment options for osteoporosis in order to prevent the incidence of fracture and the consequent costs.
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    Hea Sun Chun
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    X. Duan, J. Wang, X. Jiang
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    Hun-Kyu Shin, Jong-Hyon Park
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    Hoo-Sun Chang, Han-Joong Kim, Chung-Mo Nam, Seung-Ji Lim, Young-Hwa Jang, Sera Kim, Hye-Young Kang
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    Yong-Chan Ha
    Journal of the Korean Fracture Society.2011; 24(1): 114.     CrossRef
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    Kyung Sik Park
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Strengthening Causal Inference in Studies using Non-experimental Data: An Application of Propensity Score and Instrumental Variable Methods.
Myoung Hee Kim, Young Kyung Do
J Prev Med Public Health. 2007;40(6):495-504.
DOI: https://doi.org/10.3961/jpmph.2007.40.6.495
  • 6,337 View
  • 99 Download
  • 8 Crossref
AbstractAbstract PDF
OBJECTIVES
This study attempts to show how studies using non-experimental data can strengthen causal inferences by applying propensity score and instrumental variable methods based on the counterfactual framework. For illustrative purposes, we examine the effect of having private health insurance on the probability of experiencing at least one hospital admission in the previous year. METHODS: Using data from the 4th wave of the Korea Labor and Income Panel Study, we compared the results obtained using propensity score and instrumental variable methods with those from conventional logistic and linear regression models, respectively. RESULTS: While conventional multiple regression analyses fail to identify the effect, the results estimated using propensity score and instrumental variable methods suggest that having private health insurance has positive and statistically significant effects on hospital admission. CONCLUSIONS: This study demonstrates that propensity score and instrumental variable methods provide potentially useful alternatives to conventional regression approaches in making causal inferences using non-experimental data.
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    Minsoo Jung
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    Alex Harris, Rachelle Reeder, Jenny Hyun
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Effects of Private Health Insurance on Health Care Utilization and Expenditures in Korean Cancer Patients: Focused on 5 Major Cancers in One Cancer Center.
Jin Hwa Lim, Kui Son Choi, Sung Gyeong Kim, Eun Cheol Park, Jae Hyun Park
J Prev Med Public Health. 2007;40(4):329-335.
DOI: https://doi.org/10.3961/jpmph.2007.40.4.329
  • 6,218 View
  • 64 Download
  • 10 Crossref
AbstractAbstract PDF
OBJECTIVES
To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. METHODS: The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. RESULTS: Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. CONCLUSIONS: We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.
Summary

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Strategy Considerations in Genome Cohort Construction in Korea.
Joohon Sung, Sung Il Cho
J Prev Med Public Health. 2007;40(2):95-101.
DOI: https://doi.org/10.3961/jpmph.2007.40.2.95
  • 4,589 View
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AbstractAbstract PDF
Focusing on complex diseases of public health significance, strategic issues regarding the on-going Korean Genome Cohort were reviewed: target size and diseases, measurements, study design issues, and followup strategy of the cohort. Considering the epidemiologic characteristics of Korean population as well as strengths and drawbacks of current research environment, we tried to tailor the experience of other existing cohorts into proposals for this Korean study. Currently 100,000 individuals have been participating the new Genome Cohort in Korea. Target size of de novo collection is recommended to be set as between 300,000 to 500,000. This target size would allow acceptable power to detect genetic and environmental factors of moderate effect size and possible interactions between them. Family units and/or special subgroups are recommended to parallel main body of adult individuals to increase the overall efficiency of the study. Given that response rate to the conventional re-contact method may not be satisfactory, successful follow-up is the main key to the achievement of the Korean Genome Cohort. Access to the central database such as National Health Insurance data can provide enormous potential for near-complete case detection. Efforts to build consensus amongst scientists from broad fields and stakeholders are crucial to unleash the centralized database as well as to refine the commitment of this national project.
Summary
The Determinants of Purchasing Private Health Insurance in Korean Cancer Patients.
Jin Hwa Lim, Sung Gyeong Kim, Eun Mi Lee, Sin Young Bae, Jae Hyun Park, Kui Son Choi, Myung Il Hahm, Eun Cheol Park
J Prev Med Public Health. 2007;40(2):150-154.
DOI: https://doi.org/10.3961/jpmph.2007.40.2.150
  • 7,437 View
  • 67 Download
  • 13 Crossref
AbstractAbstract PDF
OBJECTIVES
The aim of this study is to identify factors determining the purchase of private health insurance under the mandatory National Health Insurance(NHI) system in Korea. METHODS: The data were collected by the National Cancer Center in Korea. It includes cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer. Data were gathered from the hospital Order Communication System (OCS), medical records, and face-to-face interviews, using a structured questionnaire. Clinical, socio-demographic and private health insurance related factors were also gathered. RESULTS: Overall, 43.9% of patients had purchased one or more private health insurance schemes related to cancer, with an average monthly premium of won 65,311 and an average benefit amount of won 19 million. Females, younger aged, high income earners, national health insurers and metropolitan citizens were more likely to purchase private health insurance than their counterparts. CONCLUSIONS: About half of Korean people have supplementary private health insurance and their benefits are sufficient to cover the out-of-pocket fees required for cancer treatment, but inequality remains in the purchase of private health insurance. Further studies are needed to investigate the impacts of private health insurance on NHI, and the relationship between cancer patients' burden and benefits.
Summary

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    Dong Wook Shin, Kee-Taig Jung, Sung Kim, Jae-Moon Bae, Young-Woo Kim, Keun Won Ryu, Jun Ho Lee, Jae-Hyung Noh, Tae-Sung Sohn, Young Ho Yun
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    Jin Hwa Lim, Kui Son Choi, Sung Gyeong Kim, Eun-Cheol Park, Jae Hyun Park
    Journal of Preventive Medicine and Public Health.2007; 40(4): 329.     CrossRef
Original Articles
Assessment of the Availability of Health Insurance Data for Epidemiologic Study of Childhood Aseptic Meningitis.
Sue Kyung Park, Hae Kwan Cheong, Moran Ki, Young Mo Son, Ho Kim
Korean J Prev Med. 2003;36(4):349-358.
  • 28,028 View
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AbstractAbstract PDF
OBJECTIVES
Aseptic meningitis is a major cause of Korean childhood morbidity late spring and early summer. However, the nationwide incidences of the disease have not been reported. This study was conducted to evaluate the availability of National Health Insurance data (NHID) for the study of an epidemiological trend in the surveillance of aseptic meningitis in children. METHODS: All the claims, under A87, A87.8, and A87.9 by ICD-10, among children below 15 years of age, to the National Health Insurance Corporation, between January and December 1998, were extracted. A survey of the medical record of 3, 874 cases from 136 general hospitals was performed. The availability of the NHID was evaluated by the three following methods: 1) The diagnostic accuracy (the positive predictive value = proportion of the confirmed aseptic meningitis among the subjects registered as above disease-codes in NHID) was evaluated through a chart review, and according to age, gender, month and region of disease-occurrence. 2) The distribution of confirmed cases was compared with the distribution of total subjects from the NHID, for subjects in General hospitals, or the subjects surveyed. 3) The proportion of confirmed CSF test was confirmed, and the relating factor, which was the difference in CSF-test rate, analyzed. RESULTS: Among 3, 874 cases, CSF examinations were performed on 1, 845 (47.6%), and the CSF-test rates were different according to the medical utility (admission vs. OPD visit) and the severity of the symptoms and signs. The diagnostic accuracy for aseptic meningitis, and during the epidemic (May-Aug) and sporadic (Sept-Apr) periods, were 85.0 (1, 568/1, 845), 86.0 (1, 239/1, 440) and 81.2% (329/405), respectively. The distributions by age, sex, month or period (epidemic/sporadic) and region, in the confirmed cases, were similar to those in the NHID, in both the subjects at General hospitals and in those surveyed, to within +/-7%. CONCLUSIONS: In this paper, the NHID for the subjects registered with an aseptic meningitis disease-code might be available for an epidemiological study on the incidence-estimation of childhood aseptic meningitis, as the NHID could include both the probable and definite cases. On the basis of this result, further studies of time-series and secular trend analyses, using the NHID, will be performed.
Summary
Comparing Difference of Volume of Psychiatric Treatments between the Patient with Health Insurance and Those with Medical Assistance: For Inpatients of Korean Psychiatric Hospitals.
Dae Hee Lee, Eun Cheol Park, Chung Mo Nam, Sang Gyu Lee, Dong Han Lee, Seung Hum Yu
Korean J Prev Med. 2003;36(1):33-38.
  • 2,778 View
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AbstractAbstract PDF
OBJECTIVES
To assess the difference in the volume of psychiatric treatments provided to health insurance inpatients, compared with those on medical assistance (the medical aid program) Korean psychiatric hospitals, and to determine factors which affect the volume of the services. METHODS: 21 psychiatrists, from 3 Korean psychiatric hospitals recorded the frequencies psychiatric treatments provided to inpatients in one week (February18-24, 2002). The records of 329 patients were analyzed through t-tests, and random effectmixed model analyses to define the difference between the two groups, and to find other factors affecting the volume of service. RESULTS: A significant difference in the volume of psychiatric treatments provided was observed between the health insurance and medical assistance groups. The variation in the volume of service between hospitals was prominent, and other factors (gender, agegroup, length of stay and mental disorder) were also found to be significant. The patients on medical assistance received only 70% of the psychiatric treatments of those on health insurance. CONCLUSIONS: More effort is required to improve the methods of payment to increase the level of fee scheduling for medical assistance. Further studies on the mechanisms causing these differences in the volume of service are required.
Summary
Risk Factors for Cerebrovascular Disorders in Koreans.
Jong Ku Park, Ki Soon Kim, Chun Bae Kim, Tae Yong Lee, Duk Hee Lee, Kwang Wook Koh, Kang Sook Lee, Sun Ha Jee, Il Suh, So Yeon Ryu, Kee Ho Park
Korean J Prev Med. 2001;34(2):157-165.
  • 2,821 View
  • 24 Download
AbstractAbstract PDF
OBJECTIVES
To identify the risk factors of cerebrovascular disorders(CVD) in Koreans using a nested case-control study. METHODS: The cohort consisted of beneficiaries who had taken health examinations of the Korea Medical Insurance Corporation (KMIC cohort: 115,600 persons) in 1990 and 1992 consecutively. Four hundred and twenty five (425) cases were selected following the validation of diagnosis among 2,026 reported CVD (I60-I68) inpatients during the year from 1993 to 1997. Controls were matched (1:1) with age and gender of the cases among inpatients without CVD during the same period. The source of data in this study were the files of the 1990 health examinations and the 1992 health questionnaires, as well as an additional telephone survey undertaken from March to November 1999. RESULTS: In a bivariate analysis and multiple logistic regression analysis, risk factors for total CVD were hyperglycemia and hypertension. Unrespectively, the odds ratio of ex-smoker was significantly lower than that of those who had never smoked. The risk factors for ischemic CVD also were hyperglycemia and hypertension. However, only blood pressure was found to be a risk factor for hemorrhagic CVD. Hypercholesterolemia was not a risk factor for total CVD, ischemic CVD, and hemorrhagic CVD. CONCLUSION: We concluded that the most important risk factor for CVD (including subtype) in Koreans was hypertension.
Summary
Change of Medical Utilization Claims in Self-employees before and after the Economic Crisis in Korea.
Sin Jae Lee, Ok Ryun Moon, Won Ki Jhang, Soon Ae Choi, Sang Yi Lee, Nam Soon Kim, Baek Geun Jeong
Korean J Prev Med. 2001;34(1):28-34.
  • 2,833 View
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AbstractAbstract PDF
OBJECTIVES
To investigate the changing pattern of medical utilization claims following the economic crisis in Korea. METHODS: The original data consisted of the claims of the 'Medical insurance program of self-employees' between 1997 and 1998. The data was selected by medical treatment day ranging between 1 January and 30 June. Medical utilizations were calculated each year by the frequency of claims, visit days for outpatients, length of stay for inpatients, total days of medication, and the sum of expenses. RESULTS: The length of stay as an inpatient in 1998 was decreased 4.7 percent in comparison to 1997. However, inpatient expenses in 1998 increased 10.8 percent as compared to 1997. Inpatient hospital claims in 1998 increased 6.2 percent over 1997, although general hospital inpatient claims in 1998 decreased 3.3 percent in comparison to 1997. The outpatient claim frequency decreased 7.3 in 1998 percent as compared to 1997. Outpatient visit days of in 1998 were decreased 8.5 percent in comparison to that recorded in 1997. Outpatient claim frequencies of 'gu region' in 1998 decreased 10.5 percent comparison to that in 1997, but 'city and gun region' decreased less than 'gu region'. CONCLUSIONS: Medical utilization in 1998 deceased in relation to 1997. Medical utilization by outpatients decreased more than that of inpatients. Medical utilization by 'gu regio n' decreased more than the other regions.
Summary
Impacts of DRG Payment System on Behavior of Medical Insurance Claimants.
Beom Man Ha, Gilwon Kang, Hyoung Keun Park, Chang Yup Kim, Yong Ik Kim
Korean J Prev Med. 2000;33(4):393-401.
  • 2,855 View
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AbstractAbstract PDF
OBJECTIVES
To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. METHODS: In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. RESULTS: The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.9% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). CONCLUSIONS: After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.
Summary
Understanding the Occurrence of Lung Cancer in Foundry Workers through Health Insurance Data .
Yeon Soon Ahn, Jae Seok Song, Seong Kyu Kang, Ho Keun Chung
Korean J Prev Med. 2000;33(3):299-305.
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AbstractAbstract PDF
CONCLUSIONS: To investigate the difference in the occurrence of lung cancer between foundry workers and non-foundry workers by comparing the number of workers diagnosed with lung cancer through health insurance data. METHODS: The study population was comprised of 28,884 workers who had undergone at least one general or special medical examination between January 1995 and December 1997 at the occupational health center. All of the subjects had health insurance during this period. We combined the medical examination data with the health insurance data to compare the number of foundry workers diagnosed with lung cancer and the number of non-foundry workers diagnosed with lung cancer. RESULTS: Seven workers were diagnosed with lung cancer among the 1,591 foundry workers, compared to twelve workers among the 27,293 non-foundry workers (odds ratio: 10.04, 95% confidence interval: 3.95-25.55). The seven foundry workers diagnosed with lung cancer were all exposed to dust, and six out these seven workers were engaged in finishing or shake-out processes. CONCLUSIONS: Although the information for this study was obtained from health insurance data, which has limitations such as accuracy and completeness, the number of foundry workers diagnosed with lung cancer was significantly higher than that of non-foundry workers. Therefore, a well-designed cohort study should be followed to confirm the higher lung cancer rates in foundry workers.
Summary
The Accuracy of ICD codes for Cerebrovascular Diseases in Medical Insurance Claims.
Jong Ku Park, Ki Soon Kim, Chun Bae Kim, Tae Yong Lee, Kang Sook Lee, Duk Hee Lee, Sunhee Lee, Sun Ha Jee, Il Suh, Kwang Wook Koh, So Yeon Ryu, Kee Ho Park, Woonje Park, Seungjun Wang, Hwasoon Lee, Yoomi Chae, Hyensook Hong, Jin Sook Suh
Korean J Prev Med. 2000;33(1):76-82.
  • 3,919 View
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AbstractAbstract PDF
OBJECTIVES
We attempted to assess the accuracy of ICD codes for cerebrovascular diseases in medical insurance claims (ICMIC) and to investigate the reasons for error. This study was designed as a preliminary study to establish a nationwide surveillance system. METHODS: A total of 626 patients with medical insurance claims who indicated a diagnosis of cerebrovascular diseases during the period from 1993 to 1997 was selected from the Korea Medical Insurance Corporation cohort (KMIC cohort: 115,600 persons). The KMIC cohort was 10% of those insured who had taken health examinations in 1990 and 1992 consecutively. The registered medical record administrators were trained in the survey technique and gathered data from March to May 1999. The definition of cerebrovascular diseases in this study included cases which met one of two criteria (Minnesota, WHO) or 'definite stroke' in CT/MRI finding. We questioned the medical record administrators to explain the error if the final diagnoses were not coded as stroke. RESULTS: The accuracy rate of the ICMIC was 83.0% (425 cases). Medical records were not available for 8.2% (51 cases) due to the closing of hospitals, the absence of a computer system or omission of medical record, etc. Sixty-three cases (10.0%) were classified as impossible to interpret due to insufficient records in 'major clinical symptoms' or 'neurological deficits'. The most common reason was 'to meet review criteria of medical insurance benefits (52.9%)'. The department where errors in the ICMIC occurred most frequently was the department for medical insurance claims in the hospital. CONCLUSION: The accuracy rate of the ICMIC was 83.0%.
Summary
Estimation of Disease Code Accuracy of National Medical Insurance Data and the Related Factors.
Euichul Shin, Yong Mun Park, Yong Gyu Park, Byung Sung Kim, Ki Dong Park, Kwang Ho Meng
Korean J Prev Med. 1998;31(3):471-480.
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AbstractAbstract PDF
This study was undertaken in order to estimate the accuracy of disease code of the Korean National Medical Insurance Data and disease the characteristics related to the accuracy. To accomplish these objectives, 2,431 cases coded as notifiable acute communicable diseases (NACD) were randomly selected from 1994 National Medical Insurance data file and family medicine specialists reviewed the medical records to confirm the diagnostic accuracy and investigate the related factors. Major findings obtained from this study are as follows: 1. The accuracy rate of disease code of NACD in National Medical Insurance data was very low, 10.1% (95% C.I.: 8.8-11.4). 2. The reasons of inaccuracy in disease code were 1) claiming process related administrative error by physician and non-physician personnel in medical institutions (47.0%), 2) input error of claims data by key punchers of National Medical Insurer (31.3%) and 3) diagnostic error by physicians (21.7%). 3. Characteristics significantly related with lowering the accuracy of disease code were location and level of the medical institutions in multiple logistic regression analysis. Medical institutions in Seoul showed lower accuracy than those in Kyonngi, and so did general hospitals, hospitals and clinics than tertiary hospitals. Physician related characteristics significantly lowering disease code accuracy of insurance data were sex, age group and specialty. Male physicians showed significantly lower accuracy than female physicians; thirties and forties age group also showed significantly lower accuracy than twenties, and so did general physicians and other specialists than internal medicine/pediatric specialists. This study strongly suggests that a series of policies like 1) establishment of peer review organization of National Medical Insurance data, 2) prompt nation-wide expansion of computerized claiming network of National Medical Insurance and 3) establishment and distribution of objective diagnostic criteria to physicians are necessary to set up a national disease surveillance system utilizing National Medical Insurance claims data.
Summary
The Possibility of Regional Health Insurance Data in Blueprinting the Local Community Health Plan.
Sang Yi Lee, Chul Woung Kim, Ok Ryun Moon
Korean J Prev Med. 1997;30(4):870-883.
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AbstractAbstract PDF
The health center has to play an important role in promoting community health and satisfying a variety of community health needs and demands in the decentralized Korea. The nearly enacted Community Health Act compels every health center to make its own health plans which intend to deal with local health problems and plan its future health care. This obligation is obviously a big burden to most health centers. They do not have experiences in and abilities of making local health care plans. In order to establish a systematic community health plan, health centers have to concentrate their efforts on enhancing the ability of making health care plan through gathering and analysing the local health informations. However, it is very difficult in reality. This is simply because it will take long time to accomplish these activities. It seems natural that various professionals and researchers participate in carrying out the process of making community health plan in the initial stage. No standardized methodology and analysing framework exist even in the health professional society. Nonetheless, it is common to introduce survey research methodologies in analysing consumer's health care utilization and cost, and in identifying factors influencing health behaviors. Many researchers and professionals have applied social survey methodologies in obtaining information on providers and health policy makers as well. The authors have found that few studies have ever utilized local health data stored at the self-employed medical insurance society as the data source of planning activities. The purpose of this study is to illustrate the usefulness of the data stored at the Sung-Dong Gu Self-employed Medical Insurance Society in establishing the community health plan. The major contents of this study are as follows ; 1. Frequency of utilization by age, area, sex, type of medical care institutions, and some major diseases 2. Medical treatment by type of medical care institutions, by classification of 21 diseases, by frequency of three-character categories 3. Medical treatment of major neoplasm and some chronic diseases by age, sex, and area. The conclusion of this study is that it is of great potentiality to find out the local health problems and to use them in blueprinting the community health plan through comparing the frequency of medical utilization analyzed by a variety of variables with NHI health data or the health data from survey research.
Summary
Completeness Estimation of the Korean Medical Insurance Data in Childhood Asthma.
M N Ha, H J Kwon, D H Kang, S H Cho, K Y Yoo, Y S Joo, J H Sung, J W Kang, D S Kim, S I Lee
Korean J Prev Med. 1997;30(2):428-436.
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AbstractAbstract PDF
OBJECTIVES
: The purpose of this paper is to estimate the completeness of the Korean Medical Insurance Data in childhood asthma. METHODS : Capture-recapture method was used to estimate the prevalence of childhood asthma and case ascertainment rate(completeness) of Korean Medical Insurance Data using two source model, 'Korean Medical Insurance Committee Data (KMICD)' and 'Nationwide Study of Asthma and Allergies in Korean Children'. The asthma cases were restricted to those who were born from 1981 to 1989 and were identified by their Resident Register Number. Asthma cases in Korean Medical Insurance Data were defined as cases coded by ICD-9 493 and ICD-10 J45. In 'Nationwide Study of Asthma and Allergies in Korean Children', asthma cases were defined as the children who had been diagnosed asthma and had experienced symptoms of asthma during the past 12 months. The defined cases in two data sources were matched by 13 digits Resident Register Number. The numbers of matched patients in two data sources were 245 of 32,825 eligible total subjects. Chapman and Wittes' nearly unbiased estimation was used for capture-recapture analysis of two data sources. RESULTS : Observed prevalence rate of childhood asthma was 5.3% and estimated prevalence rate by capture-recapture analysis was 11.6%. The highest prevalence rate was observed in 6-7 age group and the older the rate decreased. The completeness (the proportion of cases ascertained by KMICD to the total observed cases by two data sources) was 20.6%, and ranged from 10.8% to 28.8% by area. CONCLUSIONS : Invalid diagnosis of cases might overestimate the prevalence of childhood asthma and might underestimate the completeness of Korean Medical Insurance Committee Data in this study
Summary
A methodological study on simplifying claims review system in medical insurance.
Suk Il Kim, Hyung Gon Kang, Han Joong Kim, Young Moon Chae, Myongsei Sohn, Myung Keun Lee
Korean J Prev Med. 1995;28(3):640-650.
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AbstractAbstract PDF
After the introduction of National Medical Insurance in 1989, the medical demand has rapidly increased. The impact of increased medical demand was followed by an increase in the number of claims in need of review. We studied a new, fair method for reducing the number of claims reviewed. we analysed 90,583 outpatient claims submitted between september and october; claims were made for services given August of 1994. We finally suggested a screening system for claims review using a statistical method of discriminant analysis of the medical costs. The results were as follows. 1. In the cut-off group, age, days of medication, number of hospital or clinic visits, and total change were significantly high The cut-off rates according to the hospital-type and existence of accompanied disease were significantly different. 2. According to ICD, the cut-off rate was highest in peripheral enthesopathies and allied syndromes(20.76%), lowest in acute sinusitis(0.93%). The mean charges were significantly different according to ICD and existence of cut-off. 3. we build discriminant functions by ICD with such discriminant variables as patient age, sex, existence of accompanied disease, number of hospital or clinic visits, and 9 detailed hospital or clinic charges included in claim. 4. we applied the discriminant function for screening those claims that were expected to be cut-off. The sensitivities comprised from 40% to 70%, and specificities from 70% to 95% by ICD. Acute rhinitis had highest sensitivity(100.00%)and other local infections of skin and subcutaneous tissue had highest specificity(98.45%). The excepted number of cut-off was 17,762(19.61%). The total sensitivity was 49.62%, the total specificity was 82.57% and the error rate was 19.66%. We lacked economic analysis such as cost-benefit analysis. But, if the few method of screening claims using discriminant analysis were applied, the number of claims in need of review will reduce considerably.
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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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
Determinant Factors for Expenditure of the Medical Insurance Program for Self-Employeds.
Sin Kam, Jae Yong Park, Min Hae Yeh
Korean J Prev Med. 1995;28(1):153-173.
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This study was conducted to examine the determinant factors for expenditure of the medical insurance program for self-employeds based on the analysis of 1991 "The Medical Insurance program for self-Employeds Statical Yearbook", and also similar yearbooks in the metropolitan and other provinces. The major findings are as follows: We have divided benefits into these four components such as the utilization rate for out-patients. expenses per claim for out-patients as paid by the insurer, utilization rate for in-patients, and the expenses per claim for in-patients as paid by the insurer, in order to examine the determinant factors for it. The results of the study revealed the following findings: in urban areas, the supply of medical care had more influence on the benefits than other demographic and economic variables, while, in county areas, both the supply of medical care and the rate of those aged over 65 affected the provision of benefits. The determinant factors for financial balance of the medical insurance program for self-employeds are: first, the determinant factor for administrative expenses was the number of households. The more the number of household, the less the administrative expenses per the insured. This shows that the economy of scale is being. And so, the administrative district must be taken into consideration in the incorporation of small regional medical societies and should be re-organized for more efficient management. Second. in urban areas. the supply of medical care had more influence on utilization rate and expenses per claim as paid by insurer, and therefore it is necessary to control it. In county areas the supply of medical care and the rate of those aged over 65 raised the utilization rate and expenses per claim as paid by insurer. For the financial stability of county areas. a common fund for medical care for the aged and expansion of finance stabilization fund would be necessary. But, in county areas, it would be unnecessary to control the supply of medical care because it was much more insufficient than in urban areas. The vitalization of public health facilities must be carried out in county areas, for they reduced benefits. Since the more insured in a single household, the less the utilization of the medical insurance program, benefits for habilitation at home should be given consideration. The law of majority and the economy of scale were applied here, and therefore the incorporation of regional medical societies must be taken into consideration. In integrating regional medical societies, it would be absolutely necessary to review the structural differences among all regional medical societies, the medical demand of each region, and also the local characteristics of each region.
Summary
Changes in Medical Practice Pattern before and after Covering Intraocular Lens in the Health Insurance.
No Ah Choi, Seung Hum Yu, Hey Young Min, Eun Wook Chung
Korean J Prev Med. 1994;27(4):807-814.
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This study is to find out changes in medical practice at a university hospital before and after covering intraocular lens (IOL) from the health insurance benefit. The coverage started on March 1, 1993 and a total of 596 cases who were discharged from July 1 to December 31, 1992 and 580 cases who were discharged from July 1 to December 31, 1993 were analyzed. Since the standard reimbursement scheme was changed from March 1, 1993, the charges for 1992 were transformed into 1993 scheme. Major findings are as follows: Average length of stay was statistically significantly decreased from 8.24 days in 1992 to 6 86 days in 1993. Charges except IOL has been statistically significantly decreased from 501,000 won in 1992 to 444,000 won in 1993. Charges for drugs and injection have been reduced. However, charge per day for them was not much different. This is due to decrease in length of stay. Charges for laboratory tests and radiologic examination were quite the same. charges which are not covered by the insurance remained the same. The revenue of the hospital was reduced as expected. However, the hospital reduced the length of stay and increase the turnover rate in order to compensate the potential loss of revenue due to the difference of reimbursement between the out-of-pocket expense and the insurance coverage. By introducing the IOL benefit in the insurance, the insured pays less, hospital generates more revenue through shortening the hospital stay, and the total medical care cost becomes less nationwidely.
Summary
Industry of Employment and Spontaneous Abortion of Female Workers.
Joung Soon Park, Myung Chae Na, Do Myung Paek, Ok Ryun Moon
Korean J Prev Med. 1994;27(2):242-257.
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In Korea, female workforce has reached more than 40% of total working population but the effects of work on spontaneous abortion are yet to be examined. This study was conducted to investigate the occupational effects on spontaneous abortion. Medical insurance claim data were used to examine the effects of the employment status and industry of employment on spontaneous abortion The study population was composed of females, aged 15~44, who were the beneficiary of medical insurance in the month of June, 1993. The working females covered by medical insurance for industrial workers, hand the highest age-adjusted Spontaneous Abortion rate(SAB rate=claim frequency of spontaneous abortion/claim frequency of complication of pregnancy, childbirth and the puerperium), 6.65% whereas female dependants of medical insurance for industrial workers had the lowest age-adjusted SAB rate, 4.54%. Among industrial workers, the workers in manufacturing industry had the highest age-adjusted Spontaneous Abortion ratio(SAB ratio=claim frequency of spontaneous abortion/claim frequency of completely normal delivery), 43.2/100 whereas those in financing and service industry had age-adjusted SAB ratio, 16.2/100 and 20.5/100, respectively. The results of the study suggest the adverse effect of manufacturing industry on reproduction. Work environment such as chemical exposures, overwork, awkward posture, and job stress should be further studied for their effects on reproductive functions of female.
Summary
Effects of Regional Medical Insurance on Utilization of Medical Care in Urban Population.
Seok Beom Kim, Pock Soo Kang
Korean J Prev Med. 1994;27(1):117-134.
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The effects of regional medical insurance on utilization of medical care in urban population was examined in this study. The data was collected in a 2-year follow-up household survey conducted at Taegu city before and after implementation of the regional medical insurance. The study population was divided into 2 groups. Cohort I was the uninsured in 1989 and cohort II was the insured in 1989. After the coverage of medical insurance, physician visit rate per 1,000 population, use-disability ratio and use-restricted activity ratio in cohort I were increased compared to cohort II in both of acute and chronically ill people. The use-disability ratio and use-restricted activity ratio of the insured poor were lower than those of the insured nonpoor in both of cohort I and cohort II. The major reasons for pharmacy use were accessibility and affordability before the coverage of medical insurance in cohort I, however, after the coverage of medical insurance, the important reason was accessibility rather than affordabifity. In logistic regression analysis of physician visit, the significant independent variables were acute illness episode(+), chronic illness episode(+) and income(+) in both of cohort I and cohort II. In cohort I, after the coverage of medical insurance, more people replied that the medical cost of hospital and clinic was reasonable. The people who covered by the regional medical insurance were more dissatisfied with the imposed premium than those who covered by other types of medical insurance in both of cohort I and cohort II. More people in cohort II than cohort I were dissatisfied with the services from hospitals and clinics after implementation of the regional medical insurance. In conclusion. after the coverage of medical insurance, the gap between the poor and the nonpoor still exists in terms of medical care utilization.
Summary
Recognition and attitude to fundtional division between physicians and pharmacists of practising physicians and pharmacists in Taegu city.
Moo Sik Lee, Nung Ki Yoon, Suk Kwon Suh, Jae Yong Park
Korean J Prev Med. 1993;26(1):1-19.
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Mail questionnaire was administrated to 370 practising physicians and 388 pharmacists in Taegu city selected by systematic sampling to examine utilization states and opinion of pharmacy under medical care insurance programme and the attitude to the functional division between physicians and pharmacists from April to May 1992. Regarding the opinion on the outcome of drug-store under medical insurance, 71.2 percent of practicing physician answered failure but 13.4 percent of practicing pharmacists answered failure in contrast. Fifty percent of practicing physician asserted introducing functional division between physician and pharmacist while 66.9 percent of practicing pharmacist answered drug-store under medical insurance itself is successful programme. Average daily numbers of preparation of medicine was 32.2 case. Percentage of utilization of drug-store under medical insurance to average daily cases of preparing of medicine was 20 percent, percentage of utilization with physician's prescription was 0.7 percent. And 58.7 percent of practicing physician experienced outside the institute prescription. Regarding the opinion on the pros and cons of enforcing functional division between physician and pharmacist, 59.2 percent of practicing physician preferred pros and 17.7 percent cons ,but 38 percent of practicing pharmacist preferred pros and 45.5 percent cons. And pharmacist know better the content of functional division between physician and pharmacist, practicing emphasized to prevent misuse or abuse of medicine but practicing pharmacist emphasized to display physician and pharmacist's professional ability. And as an opinion on implementation style of functional division between physician and pharmacist in pros respondents, practicing physician favored mandatory enforcement (52.3%), while practicing pharmacist favored partial incomplete functional division (81.7%). As the method of prescription if functional division between physician and pharmacist will be enforced, both practicing physician and pharmacist preferred generic name (44.0%, 89%) mostly, but physician preferred brand name (35.3%) secondly. Regarding the reason for not implementing functional division between physician and pharmacist up to date, both physician and pharmacist answered problem of business right between physician and pharmacist, followed by lack of recognition, and interest of people and lack of the governmental willness. Regarding the opinion on prior decision of condition for enforcing functional division between physician and pharmacist, practicing physician and pharmacist named uneven distribution of medical facilities and drug-store between rural and urban, inequality of physician and pharmacist manpower and the problem of manpower demand and supply mostly, and practicing physician pointed out establishing attitude of acceptance on the part of pharmacist and practicing pharmacist favored establishing attitude of acceptance on the part of physician, which was different attitudes between physician and pharmacist. Following conclusion was reached; 1. Current drug-store under medical insurance program yield insufficient outcome, so we should consider program conversion from drug-store under medical insurance program to functional division between physician and pharmacist. 2. There were problem of business right and conflicts between physician and pharmacist at enforcing functional division between physician and pharmacist, so the government should search for formulating plan to resolve the problem and have neutral willness for the protection of the national health.
Summary
An Analysis on Factors Relating to Fiscal Deficit for Regional Health Insurance Program in Korea.
Han Joong Kim, Woo Hyun Cho, Sun Hee Lee, Hyung Kon Kang, Yang Kyun Kim
Korean J Prev Med. 1992;25(4):399-412.
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This study was designed to investigate factors relating to fiscal deficit for regional health insurance. The financial statements for the fiscal year 1990 of nationwide 254 regional medical insurance societies were analyzed. Important findings are summarized below: 1. There were differences in the main reason for the financial deficit among regions when deficit and surplus societies were compared by regions. The total revenue per enrollee, especially revenue from the premium contribution of a deficit society was significantly smaller than that of a surplus society in large cities and counties. On the other hand, the total expenditure per enrollee of a deficit society was larger than that of a surplus society in small cities. 2. Both low premium irate at the beginning of health insurance program and less effort to increase the premium rate were main factors for the smaller revenue from the contribution of a deficit society in large cities and counties. 3. Larger expenditures per covered person of a deficit society in small cities were explained with larger medical expenditures especially for out-patients services rather than larger administrative expenses. 4. A regression analysis showed that utilization rates in out-patient services were significantly associated with income and numbers of total medical care institution per capita within a region where a health insurance society located. Also expenses paid by insurer per visit were associated with the proportion of utilization for tertiary care hospitals as well as the proportion of utilization of public health centers.
Summary
Minimum Optimal Scale of the Self-Employed Health insurance Programs in Korea.
Gang Won Park, Jung Un Lee, Hae Kyung Kim, Ok Ryun Moon
Korean J Prev Med. 1992;25(4):333-342.
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The purpose of this study is to estimate the minimum optimal scale(MOS) of the self-employed health insurance associations. Considering the high proportion of operating expenses, the author have selected 254 regional health insurance associations from the 1990 Finance Report of the self-employed health insurance programs. both a quadratic function and a hyperbolic function were chosen for the analysis. The dependent variables are the average maintenance cost per insured person and per household, and the independent variables are the number of insured members and of household. The minimum optimal scale was obtained from the differentiation of the quadratic function. Major findings are summarized as follows: 1. The M.O.S. was calculated as 166,174 members (27,442 households) for the rural self-employed health insurance associations and 258,462 members (75,446 households) for the urban. Providing that both the rural and urban health insurance associations would e integrated, the M.O.S. be found to become 231,687 members (68,101 households) 2. Compared with the optimal minimum scale, the magnitude of the current health insurance association found to be much smaller, less than half of the optimal scale. 3. In order to reduce the operating cost, it is necessary to enlarge the operational scale of self-employed health insurance associations.
Summary
Impact of increasing the level of copayments on the number of physician visits.
Ki Hong Chun, Hang Jung Kim
Korean J Prev Med. 1992;25(1):73-87.
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The level of copayment increased in order to stabilize the financial condition of the health insurance on 1986. An important question regarding the policy was whether the increase in the level of copayments reduced the utilization of medical services in the poor selectively. In spite of the importance of the research question, no study has been reported. This study was designed to find out changes in nuniU rs of physician visits, to explain charac teristics influencing the difference of utilization before and after the program. Finally the interaction effect between the program and the level of income was examined for the abover question. A total of 10,421 persons from eight institutions was selected as the study sample. Research findings are as follows. 1. The number of physician visits decreased by ten percent as a result of increasing the level of copayment. 2. The decrease was remarkable in some groups such as children, rural area and large family. 3. The most important factor which explained the difference was the number of physician visits before the introduction of the new program.. The more numbers of physian visits during the last year were, the more numbers of physian visits decreased after the program. 4. The interaction term between the program and the level of income was statistically significant in the multiple regression model which explained physician visits and its coefficient was negative. It means that an increase in copayment did not reduced the number of physician visits in the poor, selectively. 5. It can be concluded that imposing adequate copayment reduces the use of medical services as well as medical costs without serious damage in access especially for the poor pule.
Summary
The effects of insurance coverage on the medical care utilization in public health institutions in a rural area.
Jea Jun Choi
Korean J Prev Med. 1991;24(3):265-278.
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This study was to examine the effects of insurance coverage on the utilization of public health institutions and to identify the factors associated with the utilization. The data were obtained from household interview surveys conducted twice in Hwachun Gun, Kangwon Do. The time period covered in the first survey was December 17~31, 1987, before the implementation of regional medical insurance for the self-employed, and that of the second survey was January 28~February 11, 1990, after its implementation. Major findings emerged from the analysis can be summarized as follows. (1) Medical care utilization of rural people markedly increased after they were covered by medical insurance. The insurance coverage increased the utilization of public health institutions as well, and this increase was mainly attributable to the utilization by chronically ill patients. (2) Between 1987 and 1990, the proportion of the utilization of public health institutions over whole medical care utilization decreased. But the proportion increased for chronically ill patients covered by regional medical insurance during the same time span. (3) The results of logistic regression suggested that the rural self-employed utilized public health institutions at an increased rate after they were covered by medical insurance. It was also indicated that the increase resulted from the utilization by chronically ill patients. (4) The relative importance of public health institutions for rural medical care decreased after the implementation of regional medical insurance. But considering that the utilization of public health institutions by chronically ill patients increased after insurance coverage, attention should be directed to improving the capability of public health institutions to control chronic degenerative diseases.
Summary
An analysis of contributing factors to financial status of regional health insurance.
Jong Kook Moon, Myeong Ho Park, Yong Joon Kim
Korean J Prev Med. 1991;24(2):211-220.
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AbstractAbstract PDF
Finances of health insurance can be explained by factors determining benefit expense and premium collection. This study was conducted to analyze factors contributing to the financial status of rural health insurance. Nationwide 134 health insurance associations except the six pilot project counties were analyzed and obtained the followings. 1. In univariate analysis, statistically significant variables that explain 1) outpatient benefit expenditures include public health center utilization, proportion of pregnant women, premium and collection rate of premium 2) inpatient benefit expenditures include public health center utilization, proportion of old age, proportion of pregnant women, premium and collection rate of premium 3) profits include public health center utilization, proportion of old age, proportion of pregnant women and collection rate of premium. 2. In multiple regression analysis, statistically significant determinants in 1) outpatient benefit include premium and public health utilization 2) inpatient benefit include premium 3) profit include public health center utilization, premium and collection rate of premium.
Summary
Study of Cancer Cases by Industry in Kwangju-Chonnam Area: Based on Industrial Medical Insurance Record.
Yong Sik Kim, Won Moon Oh, Hyung Cheol Park, Jin Su Choi, In Hyun Song
Korean J Prev Med. 1990;23(2):207-215.
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AbstractAbstract PDF
In order to investigate the occurrence characteristics of cancer in terms of industry in Kwangju-Chonnam area, medical utilization records of industrial medical insurance corporations during the period of 1987 to 1988 were reviewed for the identification of neoplastic disease. The cases obtained from the medical records were followed up for the verification and to get additional information. Standardized incidence data were compared by occupational characteristics. Multiple logistic regression analysis was applied to analyze the difference of incidence or distribution of cancer as a whole or of some selected cancer. Total cases of cancer identified were 242 during the study period. Annual incidence rate was calculated as 123.1 per 100,000 person. The frequent types of cancer were cancers of stomach, liver, lung, colon and rectum, bladder and lymphoma in descending order. Employees of mine and other sand handling industries showed significantly higher risks for cancer of stomach and cancer as a whole. Employees of the transportation industry showed the higher risk for cancer of liver. Workers in small-sized industry (< or = 100) had a higher risk for cancer than who in large-sized industry (>100). These findings suggested the effect of occupational environmental exposure to cancer development.
Summary
Change in Medical Care Utilization over Time in Early Years of Insurance Coverage.
Byoung Yik Kim, Youngjo Lee, Dal Sun Han
Korean J Prev Med. 1990;23(2):185-193.
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The purpose of this study is to observe the pattern of change in medical care utilization over time in early years of insurance coverage. The source of data is the benefit records file of a voluntary medical insurance society for covering the four-year period, from 1982 to 1985. The measure of medical care utilization used in this study is the age-sex standardized percentage of the enrollee who have visited a physician over total analytical population during a three-month period. For six cohorts by the year of enrollment (1979-1984), the relationship between the utilization and duration of insurance coverage was examined controlling for the calender year and season. In the analysis, logistic multiple regression and residual analysis were employed. It was observed that medical care utilization rapidly increased during the early stage of insurance coverage, and after then increased at a slower rate over time to become almost stable in about twenty months.
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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AbstractAbstract 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
JPMPH : Journal of Preventive Medicine and Public Health
© Korean Society for Preventive Medicine.
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