• Health Policy and Management
• /
• v.29 no.2
• /
• pp.184-194
• /
• 2019

Background: The extent of coverage rate of the public health insurance is still insufficient to meet healthcare needs. Private health insurance (PHI) plays a role to supplement coverage level of national health insurance in Korea. It is expected that reduce unmet need healthcare. This study was aimed to identify relationship between PHI type and the unmet healthcare need and its associated factors. Methods: Data were obtained from the 2014 Korea Health Panel Survey using nationally representative sample was analyzed. Respondents were 8,667 who were adults over 20 years covered by PHI but have not changed their contract. According to the enrollment form, PHI was classified into three types: fixed-benefit, indemnity, and mixed-type. To identify factors associated with unmet needs, multiple logistic regression conducted using the Andersen model factors, which are predisposing factors, enabling factors, and need factors. Results: Our analysis found that subjects who had PHI with mixed-type were less likely to experience unmet health care needs compared than those who did not have it (odds ratio, 0.80; 95% confidence interval, 0.66-0.98). As a result of analyzing what affected their unmet healthcare needs, the significant factors associated with unmet medical need were gender, marital status, residence in a metropolitan area, low household income, economic activity participation, self-employed insured, physically disabled, low subjective health status, and health-risk factors such as current smoking and drinking. Conclusion: The results of this study suggest that having PHI may reduce experience of unmet healthcare needs. Findings unmet healthcare needs factors according to various subjects may be useful in consideration of setting policies for improving accessibility to healthcare in Korea.

• Health Policy and Management
• /
• v.31 no.2
• /
• pp.197-206
• /
• 2021

Background: The purpose of this study was to identify factors affecting unmet healthcare needs due to physical accessibility by residential area by utilizing the Korea Community Health Survey (KCHS). Methods: Andersen's medical service behavioral model was applied to analyze the enabling factors, predisposing factors, and needs factors of unmet healthcare needs focusing on residential areas. This study used data from the KCHS (2017-2019, n=440,792). We used multivariate survey logistic regression analysis in order to identify affecting factors. Sub-group analysis was conducted in order to evaluate the effects of residential areas. Results: Some participants (2,621, 0.59%) had experienced unmet healthcare needs due to physical accessibility and 2,047 subjects (78.1%) of them lived in rural areas. Multivariate survey logistic regressions revealed that experience of unmet healthcare needs due to physical accessibility increased when people lived in rural areas (odds ratio [OR], 3.95; 95% confidence interval, 3.46-4.51). Conclusion: This study showed that despite the development of transportation and efforts to alleviate medical inequality, residents in rural areas may still have higher experience of unmet healthcare needs due to physical accessibility compared to the metropolitan city regardless of any other sub-group differences (OR range, 1.90-6.31). This study suggested that government and policymakers should identify the causes of the experience of unmet healthcare needs due to physical accessibility and should develop policies to alleviate those healthcare disparities.

• Health Policy and Management
• /
• v.33 no.4
• /
• pp.389-399
• /
• 2023

Background: The purpose of this study is to analyze the factors affecting the unmet healthcare needs of older people with chronic diseases in Korea and provide a basic research report to strengthen their access to medical care. Methods: In the 2020 older people survey data, 8,182 older people aged 65 or older who were diagnosed with one or more chronic diseases were the final subjects of the study. According to Andersen's behavioral model used in unmet healthcare needs, independent variables were composed of predisposing factors, possible factors, and necessary factors, and whether or not unmet healthcare needs was set as dependent variable. Results: Of the older people with chronic diseases, 1.6% experienced unmet healthcare needs, of which 55.9% experienced unmet healthcare needs for reasons related to economic burden, 31.6% physical constraints, and 12.5% time constraints. As a result of the analysis, older people with chronic diseases were more likely to experience unmet healthcare needs if they were relatively low in age, low in education level, no spouse, low in household income, poor subjective health, complex chronic diseases, and functional restrictions. However, by major reasons for experiencing unmet healthcare needs, living in rural areas were more likely to experience unmet healthcare needs due to physical constraints, and those who participated in economic activities and who had were more likely to experience unmet healthcare needs due to time burden. These results were not derived when only unmet healthcare needs was set as the dependent variable. Conclusion: This study emphasizes the need for an approach by cause of unmet medical occurrence by suggesting that there are differences in influencing factors by reason for experiencing unmet healthcare needs.

• Journal of Oriental Neuropsychiatry
• /
• v.34 no.4
• /
• pp.349-358
• /
• 2023

Objectives: We used the 2019 Korea Health Panel Annual Data to analyze factors related to visits to Korean medicine (KM) outpatient clinics among patients with mood disorders in Korea. Methods: Individuals aged 19 years or older, with depressive or bipolar disorders, and with a record of using Western medicine (WM) and/or the KM medical service were included. The 266 subjects were classified into the WM group or the integrative medicine (IM) group. The Andersen healthcare utilization model was used to analyze factors that potentially influenced the subjects' healthcare utilization. Binomial logistic regression analysis was used to analyze factors influencing the use of IM medical services. Results: Among the subjects, 75.56% (n=201) were in the WM group, and 24.44% (n=65) were in the IM group. Statistically significant differences were observed in residential areas, total annual income, the presence of disability, and the level of pain/discomfort between the two groups. Regression analysis found that residential areas and pain/discomfort were factors related to the use of IM services. Specifically, reporting "a lot" of pain/discomfort compared to "no" pain/discomfort showed a significant positive relationship with the use of IM (odds ratio=4.57, 95% confidence interval=1.79 to 11.70). Conclusions: This study was the first to analyze the status of KM medical service use and related factors among patients with mood disorders in Korea. The finding that the presence of pain/discomfort was positively correlated with the use of KM services is potentially related to medically unexplained physical symptoms or somatization phenomena.

• Journal of Pharmacopuncture
• /
• v.27 no.2
• /
• pp.110-122
• /
• 2024

Objectives: This study analyzed the Korea Health Panel Annual Data 2019 to investigate factors related to the use of non-insured Korean medicine (KM) treatment in individuals with chronic diseases. The non-insured KM treatments of interest were herbal decoction (HD) and pharmacopuncture (PA). Methods: Among adults aged 19 or older, 6,159 individuals with chronic diseases who received outpatient KM treatment at least once in 2019 were included. They were divided into three groups according to the KM treatment used: (1) basic insured KM non-pharmacological treatment (BT) group (n = 629); (2) HD group (n = 256); (3) PA group (n = 184). Logistic regression analysis was used to explore factors associated with favoring HD or PA use over BT. Potentially relevant candidate factors were classified using the Andersen Behavior Model. Results: Compared to BT, the 1st to 3rd quartiles of income compared to the 4th quartile (odds ratio: 1.50 to 2.06 for HD; 2.03 to 2.83 for PA), health insurance subscribers compared to medical aid (odds ratio: 2.51; 13.43), and presence of musculoskeletal diseases (odds ratio: 1.66; 1.91) were significantly positively associated with HD and PA use. Moreover, the presence of cardiovascular disease (odds ratio: 1.46) and neuropsychiatric disease (odds ratio: 1.97) were also significantly positively associated with HD use. Conclusion: The presence of some chronic diseases, especially musculoskeletal diseases, was significantly positively associated with HD and PA use, while low economic status was significantly negatively associated with HD and PA use, indicating the potential existence of unmet medical needs in this population. Since chronic diseases impose a considerable health burden, the results of this study can be used for reference for future health insurance coverage policies in South Korea.

• Journal of Korean Medicine for Obesity Research
• /
• v.24 no.1
• /
• pp.41-53
• /
• 2024

Objectives: We used the Korea Health Panel Annual Data 2019 to analyze factors related to visits to both Korean medicine and Western medicine (WM) outpatient clinics among patients with overweight and obesity. Methods: The inclusion criteria for this study are as follows: 1) adults over 18 years of age, 2) overweight or obese with a body mass index of 25.0 or more, 3) visited WM outpatient clinics at least once during 2019. Total 2,963 individuals were included in WM group or integrative medicine (IM) group. Using the Andersen healthcare utilization model, factors related to healthcare utilization of the participants were classified. Binomial logistic regression analysis was used to analyze factors associated with IM use. Results: Among the participants, 80.49% (n=2,385) were assigned to WM group and 19.51% (n=578) to IM group. As a result of the regression analysis, factors significantly related to the use of IM included the elderly over 65 years of age, sex (men), college or higher education level, residential area (Gwangju/Jeolla/Jeju), presence of cancer, and presence of musculoskeletal disease. The main diagnosis associated with both WM and IM use was most frequently musculoskeletal conditions. Also, IM group received WM treatment for musculoskeletal conditions more frequently compared to WM group. Conclusions: This study is the first to analyze healthcare utilization patterns among overweight or obese patients in Korea. The current findings suggest that the presence of musculoskeletal conditions, especially in this population, may be strongly associated with concurrent use of IM services.

• The Journal of Korean Medicine
• /
• v.34 no.3
• /
• pp.54-68
• /
• 2013

Objectives: This study aimed to evaluate the effects of microparticles of Socheongryong-tang (SCRT) on chronic obstructive pulmonary disease (COPD) in a mouse model. Methods: The inhalable microparticles containing SCRT were produced by spray-drying with leucine as an excipient, and evaluated with respect to the aerodynamic properties of the powder by Andersen cascade impactor (ACI). Its equivalence to SCRT extract was evaluated using lipopolysaccharide (LPS) and a cigarette-smoking (CS)-induced murine COPD model. Results: SCRT microparticles provided desirable aerodynamic properties (fine particle fraction of $49.6{\pm}5.5%$ and mass median aerodynamic diameter of $4.8{\pm}0.3{\mu}m$). SCRT microparticles did not show mortality or clinical signs over 14 days. Also there were no significant differences in body weight, organ weights or serum chemical parameters between SCRT microparticle-treated and non-treated groups. After 14 days the platelet count significantly increased compared with the non-treated group, but the values were within the normal range. Inhalation of SCRT microparticles decreased the rate of neutrophils in blood, granulocytes in peripheral blood mononuclear cells (PBMC) and bronchoalveolar lavage fluid (BALF) and level of TNF-${\alpha}$ and IL-6 in BALF on COPD mouse model induced by LPS plus CS. This effect was verified by histological findings including immunofluorescence staining of elastin, collagen, and caspase 3 protein in lung tissue. Conclusions: These data demonstrate that SCRT microparticles are equivalent to SCRT extract in pharmaceutical properties for COPD. This study suggests that SCRT microparticles would be a potential agent of inhalation therapy for the treatment of COPD.

• Health Policy and Management
• /
• v.33 no.1
• /
• pp.3-18
• /
• 2023

Background: A chronic disease management program including patient education, recall and remind service, and reduction of out-of-pocket payment was implemented in Korea through a chronic care model. This study aimed to assess the effect of a community-based intervention program for improving medication adherence of patients with diabetes mellitus in rural areas of Korea. Methods: We applied a non-equivalent control group design using Korean National Health Insurance Big Data. Hongcheon County has been continuously adopting this program since 2012 as an intervention region. Hoengseong County did not adopt such program. It was used as a control region. Subjects were a cohort of patients with diabetes mellitus aged more than 65 years but less than 85 years among residents for 11 years from 2010 to 2020. After 1:1 matching, there were 368 subjects in the intervention region and 368 in the control region. Indirect indicators were analyzed using the difference-in-difference regression according to Andersen's medical use model. Results: The increasing percent point of diabetic patients who continuously received insurance benefits for more than 240 days from 2010 to 2014 and from 2010 to 2020 were 2.6%p and 2.7%p in the intervention region and 3.0%p and 3.9%p in the control region, respectively. The number of dispensations per prescription of diabetic patient in the intervention region increased by approximately 4.61% by month compared to that in the control region. Conclusion: The intervention program encouraged older people with diabetes mellitus to receive continuous care for overcoming the rule of halves in the community. More research is needed to determine whether further improvement in the continuity of comprehensive care can prevent the progression of cardiovascular diseases.

• Industry Promotion Research
• /
• v.7 no.2
• /
• pp.43-49
• /
• 2022

This study aims to study Esping-Anderson's theory of welfare state system, develop a model of welfare state suitable for Korea's situation, and apply it to reality. In this research method, basic research and analysis of ideology is used, focusing on Esping-Anderson's welfare state system theory, and applying it appropriately to the Korean situation. Studies on the model of the welfare state have been studied after the classification of complementary and institutional models asserted by Willensky and Lebo in 1965. In addition, Esping-Andersen asserts three things as a model of the welfare state according to ideology. First, the role of the market is central to the liberal welfare system that best fits the image of classical capitalism, and individualistic solidarity through the market. The role of the state or family, which can be a hindrance, is actually marginalized. In addition, in order to maximize individualistic solidarity through the market, de-commodification in the national domain tends to be minimized. Second, the conservative welfare system has a strong familistic element, so the source of social solidarity is the family, and the state plays a role of supporting and supplementing the characteristics of this family. In the conservative system, de-commodification appears to be high among household heads, or the welfare system takes on a corporatist and nationalistic form, it can be said that these characteristics are reflected. Third, in the social democratic welfare system, the source of social solidarity is the state. Therefore, the role of the state is large, the state has a high possibility of decommodification, and it has the characteristics of substitutes for the family and the market through universalist intervention. This study applies Esping-Anderson's three welfare state models to study a model suitable for the Korean situation. In conclusion, Esping-Anderson's three welfare state models can be classified into a market-oriented model based on a liberal welfare system, a status-oriented model based on a conservative corporatist welfare system, and a solidarity-oriented model based on a social-democratic welfare system, presented a compromise between liberalism and conservatism as a Korean model.

• Journal of dental hygiene science
• /
• v.15 no.1
• /
• pp.60-66
• /
• 2015

The purpose of this study was to examine the relationship of predisposing, enabling, need factors and oral health care factors to the dental utilization in 4,521 senior citizens based on the 5th National Health and Nutrition Examination Survey data. As for the relationship of predisposing, enabling and need factors to the necessity of denture, higher academic credential and higher income level that were respectively one of predisposing and need factors led to a higher necessity of denture, and the relationship of these factors was statistically significant. As to influential factors for their dental utilization in Model 1, there were significant differences according to gender, marital status and whether to subscribe to private health insurance or not. In Model 2, the need factors of Model 1 were adjusted. As a result, the respondents who didn't receive any unsatisfactory dental treatment made 1.35-fold more dental utilization, and the respondents who complained about mastication difficulty made 1.34-fold more dental utilization. There were significant differences according to gender, age, marital status, academic credential, whether to subscribe to private health insurance, unsatisfactory dental treatment experience and mastication difficulty. Age, unsatisfactory dental treatment experience and whether to complain about mastication difficulty or not made statistically significant differences to the dental utilization in Model 3 that involved oral health status. The above-mentioned findings illustrated that the predisposing factors, the enabling factors and the need factors exerted an influence on the elderly dental utilization. As there are a variety of factors to affect elderly dental utilization, its required to make an effort to boost the accessibility of the elderly to dental service in order to improve their oral health of the elderly.