• Health Policy and Management
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• v.20 no.4
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• pp.1-18
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• 2010

Much policy attention has been directed to the concentration of patients in large hospitals, especially in tertiary care hospitals. In order to address the problem, the government has enforced referral requirement for accessing care in tertiary care hospitals by denying insurance benefits to the patients who do not observe the requirement. This approach somehow has failed to produce expected effects although it still exists in theory. The concentration of patients in a certain type of providers results in the distortion of functional differentiation among various types of providers and vice versa. Thus the approaches for the alleviation of the problem should be directed to both patients and providers. However, policy approaches has so far focused on ways of directly affecting patients' choice of a provider neglecting the effects of providers. Based upon the observation, this paper has reviewed selected issues that should be considered in agenda setting for policies concerned with the concentration of patients in large hospitals or the distortion of functional differentiation among health care providers. A brief discussion of each of the issues suggests three general guidelines for the formulation and implementation of policies intended to address the problem. First, attention should be directed to both patients and providers. Secondly, it is necessary to employ diverse measures including regulation, incentives and administrative supports. Thirdly, some of the approaches should be planned from a long range perspective, for it often takes a long time to change some aspects of health care utilization and provision.

• Health Policy and Management
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• v.20 no.4
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• pp.19-44
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• 2010

This study was conducted to investigate the changes in patterns of Daegu- and Gyeongbuk-based patients' use of medical care facilities located in Seoul. The 'Patient Survey' data issued by the Ministry of Health and Welfare for 2002, 2005, and 2008 were used. Among all discharged patients residing in Daegu and Gyeongbuk, 133,456 who used medical facilities in Daegu, Gyeongbuk, and Seoul were selected. Among patients residing in Daegu, 2.2% used medical facilities in Seoul in 2002, 3.7% in 2005, and 3.5% in 2008. The corresponding rates among patients living in Gyeongbuk were 5.6%(2002), 7.1%(2005), and 7.3%(2008). Regarding the ICD-10 disease groups, the use of medical facilities in Seoul by patients residing in either Daegu or Gyeongbuk increased in 2005 right after the introduction of the KTX high-speed train service, covering various disease groups, but decreased again in 2008. 'Neoplasm' cases, however, showed a progressive rising trend during the years studied. Multivariate data analysis for the three years showed that sex, age, payment type, hospital type, residence, year, and disease groups were all significantly associated with the utilization of medical facilities in Seoul. The major results are : First, use of medical facilities in Seoul by Gyeongbuk patients was 2.4-fold higher than that by Daegu patients, but with respect to 2005 and 2008 vs. 2002, use of medical facilities in Seoul by Daegu resident patients' showed a larger increase than that by Gyeongbuk's patients. Second, for patients residing in the two regions, use of medical facilities in Seoul was highest for 'congenital malformations, deformations and chromosomal abnormalities', followed by 'neoplasms'. Third, for patients residing in the two regions, general hospitals comprise the primary factor in the use of medical facilities in Seoul. The study shows that local medical facilities should individually exert more efforts to improve the quality of their medical services. Relevant authorities should likewise help these facilities develop their own unique services and respective specialization.

• Health Policy and Management
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• v.22 no.4
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• pp.538-560
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• 2012

This study tried to find out the level of national health expenditure and associated factors in the OECD countries and then to derive lessons for Korea's health financing based on the cross-national comparison. As a result, Korea's health expenditure in 2010(7.1% of GDP) accounted for 74.7 percent of the OECD average and ranked as countries to spend less on health. At the same time, the socio-economic indicators such as GDP per capita, elderly population ratio and the total tax revenue to GDP also remained between 72 ~ 82 percent of the OECD average. The public share of health financing(58.2%) was relatively lower than those of other countries. However the health expenditure and the public share have grown 1.9 ~ 2.4 times higher than the OECD average over the past decade. According to the quantitative analysis, countries with relatively high income and elderly population turned out to have high health expenditure. Whereas, an inverse relationship was found between the total health expenditure and the public funding. It was estimated that the value of national health expenditure to GDP decreases 0.083 when the rate of public funding increases 1 percent point. Further, the share of public funding was affected positively by the total tax burden. Based on these findings, this study suggests that the sustainable spending on health and alleviating households' direct burden could be ensured by enhancing the share of public funding along with adjusting the tax burden of the people.

• Health Policy and Management
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• v.22 no.4
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• pp.497-521
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• 2012

Objectives This study aimed to investigate the effect of social capital, health risk behavior and health status on medical care utilization by the elderly. The data and Research method Data were obtained from the 4th wave survey of the Korea Welfare Panel Study. 4,087 household members aged 65 years and over were subject to analysis. Descriptive statistics are used to describe the basic features of the data in a study. we performed a structural equation modeling(SEM) analysis to evaluate the effect of social capital and mediating effect of health risk behavior and health status. Results Results showed that factors related to medical care utilization of the elderly were different depending on types of service (inpatient and outpatient service) except health status. Age, higher social capital, more health-risk behavior and poorer health status were associated with increased use of inpatient service. Social capital was found to have a positive direct effect on it. Also, social capital had an indirect effect on reducing use of inpatient services by improving health status. On the other hand, lower age and higher household income tended to increase use of outpatient service, while higher social capital and higher health status were inversely related. Social capital had a direct effect and an indirect effect on reducing use of outpatient service and, at that time, health status played a mediating role. Conclusions Social capital may contribute to improve health status and indirectly reduce medical care utilization of the elderly by enhancing their health status. These results provide evidence that more policy and strategy considerations should be needed for the elderly to strengthen their social capital in order to enhance their levels of health and more efficient utilization of medical care.

• Health Policy and Management
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• v.22 no.4
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• pp.696-702
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• 2012

The purpose of this study was to evaluate the improvement of disabled access to healthcare institution located in Jongno-gu, Seoul in 2011 compared to 2003 since disabled access has been mandatory in healthcare institutions located in new buildings by the amended law in 2004. We had investigated 10 assessment items for disabled access in 166 healthcare institutions located in Jongno-gu, Seoul and the results were compared with those of 2003 survey. On average, 74.1% of the healthcare organizations has equipped with items for disabled access. However the adequately equipped rate for those items was only 39.2%. Compared with the results of 2003 survey, these rates showed a little increase by 4.1% and 8.0%, respectively. There were only 10 healthcare institutions located in new buildings which were constructed after July, 2005. Their average equipped rate(84.4%) and adequately equipped rate(46.8%) were higher than those of the other organizations because the Korean government ruled that healthcare institutions in new buildings must have facilities for the disabled. In conclusion, we confirmed that the accessibility of the disabled to healthcare institution slightly increased. In particular, the healthcare institutions in newly constructed building showed the significant increase of accessibility of the disabled. However, it is founded that disabled access is still not enough for the disabled.

• Health Policy and Management
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• v.17 no.3
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• pp.68-86
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• 2007

This study was performed to explore the effect of customer satisfaction and switching barriers on customer royalties in medical services. 900 households, 1% sample were randomly selected from K city located in Kangwon province. Interview survey was performed with structured questionnaire for the entire people, 923 persons who experienced medical service utilization during one year before survey on time, september, 2002. In comparison of switching barriers by sociodemographic characteristics, lower income group and lower educated group showed the higher level of recognition level on availability of changing the service provider significantly. In terms of economic loss as one of switching barriers, the group of over aged 61, the lower income group and the lower educated group felt higher than other groups. Also, the time loss of switching barrier was recognized in 41-60 aged group and employee in service industry highly. For the perceived risk factor as another switching barrier, the high educated group showed the higher recognition level in performance risk and felt higher social risk than other groups. In analysis of customer satisfaction and loyalty levels by switching barrier components, the lower level of availability of changing the service provider and the higher level of recognition for economic and time loss, they showed the higher satisfaction and loyalty levels. In final step, multiple regression analysis showed the positive relationship between customer satisfaction, switching barrier and customer loyalties. Besides, the moderating effect of switching barrier in relationship between customer satisfaction and loyalties was significant and this results suggests that the influence of customer satisfaction to customer loyalties might be weakened in high level of recognition for switching barrier. In conclusion, perceived risk of economic and time loss as switching barrier is an important factor and should be considered in planning of marketing strategy carefully in terms of defensive marketing.

• Health Policy and Management
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• v.28 no.1
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• pp.70-76
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• 2018

Background: The purpose of this study was to investigate the determinants of North Korean refugees' trust in South Korea health service. Methods: This study surveyed 168 North Korean refugees aged 19 and over living in Seoul, Gyeonggi, Incheon, and Gangwon. The collected data were analyzed by frequency analysis, t-test, analysis of variance, and hierarchical regression analysis to analyze the effect on the trust of refugees. Results: The difference analysis showed statistically significant difference according to duration of residence and employment status. The determinants of North Korean refugees' trust in South Korea health services were duration of residence, basic communication skills, health communication skills, and experience of health service. Conclusion: In order to increase the trust of North Korean defectors in South Korea medical services, it is necessary to resolve communication problems and improve the satisfaction of health services. For this, the interpreter service should be activated. And specific education should be given to the North Korean refugees about the health care system and the utilization methods of health service in Korea.

• Health Policy and Management
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• v.28 no.1
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• pp.48-52
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• 2018

Background: The current study evaluated the hospital utilization and characteristics of patients who received health care services for acute cerebral infarction outside their own residential area. Methods: Using the 2014 national patient survey data, information on 2,982 patients diagnosed with acute cerebral infarction through emergency department were retrieved for the analyses. Multiple logistic regression was performed to investigate the characteristics associated with using hospitals outside residential area among patients diagnosed with acute cerebral infarction. Results: Fifteen point nine percent of patients admitted for acute cerebral infarction utilized hospitals outside their residential area. Patients residing in a province were 7.7 times more likely to utilize hospitals located outside their residential areas compared to those living in Seoul metropolitan city. Patients living in Gangwon and Jeolla were 0.26 times and 0.48 times more likely to go to hospitals in different geographical areas. Also, patients within the age group of 80 years and over were 0.65 times less likely to be admitted to hospitals outside their residential area compared to those in their 40s-50s. Conclusion: The use of hospitals outside patient's residential area is shown to be substantial, given that the acute cerebral infarction requires immediate recognition and treatment. The findings on the geographical differences in the hospital utilization suggest further investigation.

• Health Policy and Management
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• v.28 no.1
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• pp.91-94
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• 2018

Unmet healthcare needs do not end with the phenomenon itself, but lead to possibilities of increased severity of illness. Missed opportunities for treatment at the right timing increase possibilities of complications, and affect prognosis of disease. To examine current status and trends of unmet needs in Korea, we used data from four sources: the Korea National Health and Nutrition Examination Survey (KNHNES, '2007-2016); the Community Health Survey (CHS '2008-2016); the Korea Health Panel Survey (KHP '2011-2014); and the Korean Welfare Panel Study (KOWEPS '2006-2016). The proportion of individual reporting unmet healthcare needs as of 2016 was 8.8% (KNHNES), 11.5% (CHS), and 12.8% (KHP, as of 2014). Annual percentage change which characterizes trend for the follow-up period was -9.9%, -3.1%, and -1.3%, respectively. The proportion of individuals reporting unmet healthcare needs due to cost was 1.8% (KNHNES), 1.5% (CHS), and 3.0% (KHP). The proportion of households reporting unmet healthcare needs due to cost was 1.0% (KOWEPS). Annual percentage change was -10.0%, -15.2%, -5.4%, and -17.5%, respectively. Low income populations had more unmet healthcare needs than high income populations. Therefore, in order to improve unmet healthcare needs, it is necessary to focus on low income populations.

• Health Policy and Management
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• v.29 no.3
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• pp.262-276
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• 2019

Background: The most important thing to strengthen primary care is to prove that the continuity of primary care is an essential area for good health outcomes. The purpose of this study is to analyze the effect of outpatient continuity of primary care on the hospitalization experience of diabetes mellitus in new diabetic patients. Methods: Using the Korean National Health Insurance Service national sample cohort (NHIS-NSC 2011-2015) data, 3,391 new diabetic patients in 2012 were selected for the study. Multiple logistic regression was performed to investigate the effect of outpatient continuity of primary care on hospitalization in new diabetic patients. Results: The outpatient continuity of primary care in new diabetic patients was measured by the continuity of care index, which showed that 69.4% (n=2,352) were high level and 30.6% (n=1,039) were low level. Patients who had high continuity of primary care at the early stage of diabetes diagnosis showed 3.49 times more likely to maintain high continuity of primary care in the second year (95% confidence interval [CI], 2.72-4.49). Patients with low continuity of primary care for 2 years from the initial diagnosis of diabetes were 2.56 times more likely to be hospitalized due to diabetes than those who did not (95% CI, 1.55-4.25). Conclusion: This study identified the need for policies to increase the continuity of primary care for new diabetic patients and could contribute to lowering the admission rate of diabetic patients if the policy for this would work effectively.