Journal of Preventive Medicine and Public Health

English Abstracts

Medical Care Utilization Status and Associated Factors with Extended Hospitalization of Psychiatric Patients in Korea.: Soo Kyung Suh, Yoon Kim, Jong Ik Park, Myung Soo Lee, Hong Suk Jang, Sun Young Lee, Jin Seok Lee; J Prev Med Public Health. 2009;42(6):416-423.; DOI: https://doi.org/10.3961/jpmph.2009.42.6.416

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OBJECTIVES
This study was performed to examine medical care utilization of psychiatric patients and to explore patients' characteristics associated with extended hospitalization. METHODS: Data were extracted from information of Korean Health Insurance Review and Assessment Service. All data associated with admission and outpatient clinic visit were analysed by patient characteristics. We selected first psychiatric admission patients who diagnosed mental and behavioral disorders due to use of alcohol (main disease code: F10), schizophrenia and related disorders (F20-29) and mood disorders (F30~33) from January to June 2005. We analysed status of admission, mean length of stay, regular access to outpatient clinic and rates of extended hospitalization during 3 years. Bivariate and multivariate analyses were conducted to identify factors associated with extended hospitalization. RESULTS: The number of psychiatric patients during the first six month of 2005 was 30,678. The mean length of stay was longest for schizophrenia and related disorders but shortest for mood disorders. Patients who experienced an extended hospitalization were 18.8% of total subjects. An extended hospitalization was more common in schizophrenia and related disorders than other diagnostic groups. The factors associated with the extended hospitalization were age, sex, diagnostic group, type of insurance and medical care utilization groups. CONCLUSIONS: The study indicates the problem of an extended hospitalization for psychiatric patients in Korea. It is suggested that variations in rates of extended hospitalization among medical care utilization group may need an active early intervention system in psychiatric treatment service. Particular attention needs to be devoted to planning and funding for reducing extended hospitalization.

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Jiho Kim, Hae-Woo Lee, Mi Yang, Hyo Been Lee, Yong Lee Jang, Eun Jin Na
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Effectiveness of a Community-Based Intensive Case Management Model on Reducing Hospitalization for People With Severe Mental Illness in Seoul
Jee Hoon Sohn, Sung Joon Cho, Hae Woo Lee, Hyun Kim, Seung Yeon Lee, Yoomi Park, Hwo Yeon Seo, Eun Soo Kim, Jee Eun Park, Bong Jin Hahm
Psychiatry Investigation.2023; 20(12): 1133. CrossRef
Differences in Social and Clinical Characteristics between Readmission and Dehospitalization in Long-Term Inpatients with Schizophrenia
Min-Sun Kim, Sunyoung Park, Jin-sook Choi
Korean Journal of Schizophrenia Research.2020; 23(1): 38. CrossRef
Continuation of schizophrenia treatment with three long-acting injectable antipsychotics in South Korea: A nationwide population-based study
Sung Woo Joo, Seung-Hyun Shon, GumJee Choi, MinJung Koh, Seung Woo Cho, Jungsun Lee
European Neuropsychopharmacology.2019; 29(9): 1051. CrossRef
The Significance and Limitations of Korean Diagnosis-Related Groups in Psychiatric Inpatients' Hospital Charges
Keun-Ho Joe, Jeong-Ho Seok, Woon Jin Jeong, Boung Chul Lee, Ae Ryun Kim, Eun kyoung Choi, Boyoon Won, Chung-Suk Lee
Journal of Korean Neuropsychiatric Association.2017; 56(1): 10. CrossRef
A Study on Factors Related to Long-term Hospitalization in Patients with Chronic Schizophrenia
Oak-Jin Jang, Byung-Dae Lee, Young-In Chung
Journal of Korean Neuropsychiatric Association.2015; 54(1): 76. CrossRef
Efficacy of Case Management for the Community Dwelling Schizophrenia Patients : A 36-Month Prospective Follow-Up Study
Jee Hoon Sohn, Seung-Hee Ahn, Su Jeong Sung, Ji Min Ryu, Ji Eun Park, Maeng Je Cho
Journal of Korean Neuropsychiatric Association.2015; 54(4): 578. CrossRef
Factors Affecting the Downward Mobility of Psychiatric Patients: A Korean Study of National Health Insurance Beneficiaries
Un-Na Kim, Yeon-Yong Kim, Jin-Seok Lee
Journal of Preventive Medicine and Public Health.2015; 49(1): 53. CrossRef
The Current Situation of Treatment Systems for Alcoholism in Korea
Jee Wook Kim, Boung Chul Lee, Tae-Cheon Kang, Ihn-Geun Choi
Journal of Korean Medical Science.2013; 28(2): 181. CrossRef
Psychosocial Correlates of Length of Stay of Institutionalized Patients with Mental Illness
Jung Kyoo Choi, Hong-Suk Jang, Myung-Soo Lee, Jin Pyo Hong, Jong-Ik Park
Journal of Korean Neuropsychiatric Association.2013; 52(2): 98. CrossRef

Prognostic Impact of Charlson Comorbidity Index Obtained from Medical Records and Claims Data on 1-year Mortality and Length of Stay in Gastric Cancer Patients.: Min Ho Kyung, Seok Jun Yoon, Hyeong Sik Ahn, Se min Hwang, Hyun Ju Seo, Kyoung Hoon Kim, Hyeung Keun Park; J Prev Med Public Health. 2009;42(2):117-122.; DOI: https://doi.org/10.3961/jpmph.2009.42.2.117

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Abstract PDF

OBJECTIVES
We tried to evaluate the agreement of the Charlson comorbidity index values (CCI) obtained from different sources (medical records and National Health Insurance claims data) for gastric cancer patients. We also attempted to assess the prognostic value of these data for predicting 1-year mortality and length of the hospital stay (length of stay). METHODS: Medical records of 284 gastric cancer patients were reviewed, and their National Health Insurance claims data and death certificates were also investigated. To evaluate agreement, the kappa coefficient was tested. Multiple logistic regression analysis and multiple linear regression analysis were performed to evaluate and compare the prognostic power for predicting 1 year mortality and length of stay. RESULTS: The CCI values for each comorbid condition obtained from 2 different data sources appeared to poorly agree (kappa: 0.00-0.59). It was appeared that the CCI values based on both sources were not valid prognostic indicators of 1-year mortality. Only medical record-based CCI was a valid prognostic indicator of length of stay, even after adjustment of covariables (beta = 0.112, 95% CI = [0.017-1.267]). CONCLUSIONS: There was a discrepancy between the data sources with regard to the value of CCI both for the prognostic power and its direction. Therefore, assuming that medical records are the gold standard for the source for CCI measurement, claims data is not an appropriate source for determining the CCI, at least for gastric cancer.

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Keh-Sen Liu, Tsung-Fu Yu, Hsing-Ju Wu, Chun-Yi Lin
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What happened to health service utilization, health care expenditures, and quality of care in patients with acute pancreatitis after implementation of global budgeting in Taiwan?
Ya-Lin Ko, Jyun-Wei Wang, Hui-Mei Hsu, Chia-Hung Kao, Chun-Yi Lin
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The impact of global budgeting on health service utilization, health care expenditures, and quality of care among patients with pneumonia in Taiwan
C.-Y. Lin, T. Ma, C.-C. Lin, C.-H. Kao
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Comparison of Hospital Standardized Mortality Ratio Using National Hospital Discharge Injury Data
Jong-Ho Park, Yoo-Mi Kim, Sung-Soo Kim, Won-Joong Kim, Sung-Hong Kang
Journal of the Korea Academia-Industrial cooperation Society.2012; 13(4): 1739. CrossRef
Predictive Ability of Charlson Comorbidity Index on Outcomes From Lung Cancer
Apar Kishor Ganti, Emily Siedlik, Alissa S. Marr, Fausto R. Loberiza, Anne Kessinger
American Journal of Clinical Oncology.2011; 34(6): 593. CrossRef
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Kyoung Hoon Kim
Journal of Preventive Medicine and Public Health.2010; 43(1): 42. CrossRef
The Impact of Medicaid Expansion to include population with low income on the preventable hospitalizations
Hyun-Chul Shin, Se-Ra Kim
Korean Journal of Health Policy and Administration.2010; 20(1): 87. CrossRef
Charlson Comorbidity Index as a Predictor of Long-Term Survival after Surgery for Breast Cancer: A Nationwide Retrospective Cohort Study in South Korea
Hye Kyung Woo, Jong Hyock Park, Han Sung Kang, So Young Kim, Sang Il Lee, Hyung Ho Nam
Journal of Breast Cancer.2010; 13(4): 409. CrossRef
A comparison of the Charlson comorbidity index derived from medical records and claims data from patients undergoing lung cancer surgery in Korea: a population-based investigation
Hyun-Ju Seo, Seok-Jun Yoon, Sang-Il Lee, Kun Sei Lee, Young Ho Yun, Eun-Jung Kim, In-Hwan Oh
BMC Health Services Research.2010;[Epub] CrossRef
Health Outcome Prediction Using the Charlson Comorbidity Index In Lung Cancer Patients
Se-Won Kim, Seok-Jun Yoon, Min-Ho Kyung, Young-Ho Yun, Young-Ae Kim, Eun-Jung Kim
Korean Journal of Health Policy and Administration.2009; 19(4): 18. CrossRef
Factors Affecting Health of the Rural Residents
Dong-Koog Son, Kyu-Sik Lee, Jong-Ku Park, Sang-Baek Koh, Ki-Nam Jin, Eun-Woo Nam, Hae-Jong Lee
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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

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Abstract 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.

Summary

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Effects of a Dementia Screening Program on Healthcare Utilization in South Korea: A Difference-In-Difference Analysis
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Effect of Socioeconomic Status on Healthcare Utilization in Patients with Rare and Incurable Diseases
Jun Im, Myeong-Hui Kim, Jeong-Su Im, Dae-Gyu O
Korean Journal of Health Policy and Administration.2009; 19(4): 66. CrossRef

Original Articles

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.

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Abstract 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

A study on the trend in the length of hospital stay in Korea.: Woo Hyun Cho, Ki Hong Chung, Im Ok Kang; Korean J Prev Med. 1996;29(1):51-66.

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Abstract PDF: The purpose of this study was to examine the trends of length of hospital stay (LOS), which is most likely to be a major attribute to hospital performance From 1984 to 1994, an average LOS of each hospital was analyzed by factors such as medical departments, bed size, occupancy rate, region and ownership. This study was analyzed changing rate of LOS during 11 years. This rate was calculated by simple regression, which was used only with hospital without missing data during 11 years. This study findings are as follows. 1. The results indicated that the average LOS was steadily increased until 1990 but it was slightly decreased after 1990. 2. This trend could be found in all hospital scale and all group of occupancy rate. Specifically this trends of LOS were found in internal medicine, corporate owned hospitals, and hospitals in major city. But LOS of individual owned hospital was continuously increased until 1994. 3. Means of changing rates of LOS were calculated from 1984 to 1994. If we divided it into two parts, before 1990 and after 1990, most changing rates of LOS before 1990 except individual owned hospital were found positive sign. The changing rates after 1990 were negative sign but small hospital(lesser then 200 bed), individual owned hospital, national & public hospital and hospital in small urban have little change of LOS after 1990. Finally from this results we thought that most hospitals in korea began to be concerned with LOS. Nevertheless LOS of several hospital such as small hospital or individual owned hospital was increased. And this trend may be caused by a few patients, low occupancy rate, or low profit. This trend of LOS is different from that of other countries. Perhaps this phenomenon is resulted from the reimbursement method. Because of fee for service reimbursement system in korea the hospitals didn't need to shorten LOS in order to save the cost and increase the profit. Therefore reform of hospital cost reimbursement method will be reduced to reduce hospital cost in korea. we thought that the korean health authority should consider the reimbursement method by unit of bundle of services, for example DRG and prepayment in the united states. This study presents some limitations such as on insight of severity of disease, case-mix measurement of hospital, and other clinical characteristics that can possibly affect LOS, However, this study reports an important trend in LOS from 1984 to 1994.; 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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Abstract PDF: 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

The Study on Volume Relationships in Several Diseases.: Sunhee Lee, Yonggweon Jwa; Korean J Prev Med. 1994;27(4):793-806.

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Abstract PDF: Investigating the existence of volume-outcome relationships for specific disease groups relates directly to the policy issue of whether, and how, specific inpatient services should be regionalized. This study examined whether medical costs and lengths of stay as outcomes were affected by changes in volume within hospitals. Based on the claims data obtained from National Federation of Medical Associations, each six disease categories from medical and surgical conditions were selected and 29,720 cases from 1,266 hospitals were analyzed. Main findings of the research can be summarized as follows: 1. Analyzing volume and cost per case relationship, tonsillectomy class 1, hernia procedure class 0, appendectomy and cesarean section class 0,1 in surgical conditions showed negative relationship significantly. In cases of medical conditions, costs per case in respiratory neoplasm class 2, COPD class 1, 2, digestive malignancy were also related to volume negatively. 2. Comparing volume with length of stay per case, lens procedure class 0, hernia procedure class 0, appendectomy class 0,1 cesarean section class 1 in surgical conditions showed negative relationships significantly. In medical conditions, volume of respiratory neoplasm class 2, COPD class 1,2, digestive malignancy class 0 were associated with negatively. 3. within same disease categories, changes in cost and length of stay per case to volume were more remarkable in severe cases. These results suggested a significant inverse relationship between disease cases and cost, length of stay per case as outcome variables.; Summary

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