• Korean Journal of Social Welfare
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• v.60 no.4
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• pp.231-251
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• 2008

Academic interest has been drastically increased for the health disparities due to socioeconomic factors. For those who have a chronic illness such as diabetes, various psychosocial barriers related to illness management might affect and aggravate this disparity. This study focused on illness management barriers experienced by people with diabetes, and examined the differences by their Medicaid beneficiary status. The between group differences in illness management barriers, family support and health status were examined as well as the association between illness management barriers and health status. The sample of this study consists of 144 community dwelling adults who have diabetes, recruited from an outpatient diabetes clinic and a community welfare center. Medicaid beneficiaries reported poorer health status, and experienced more illness management barriers compared to their counterparts. Statistically significant differences were observed in barriers due to mental health, financial status, and lack of support. The between group difference in health status remained significant after controlling for the effect of demographic characteristics and illness related factors. Social work practitioners working with this population should address these illness management barriers to reduce socioeconomic health disparity.

• Journal of Preventive Medicine and Public Health
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• v.23 no.4 s.32
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• pp.451-464
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• 1990

The variation in resource utilization for hospitalized patients who had a group of similar diseases -- a Korean Diagnosis Related Group (KDRG) -- among the same type of hospitals was studied to assess the utillization variation due to the practice pattern of hospitals. Information about inpatients who were beneficiaries of the medical insurance for teachers and government officials discharged from 20 large university teaching hospitals in Seoul during 1986 and information about the hospitals were analyzed to achieve the study objective. A total of 20,223 non-outlier patients in 100 most frequent KDRGs were included in the analysis. Case charges after the review and length of stay (LOS) were used as measures of resource utilization during a hospitalization. A substantial variation among hospitals was found in most KDRGs : o the ratio of the maximum and the minimum among the mean case charges of hospitals was greater than 2 in 83 KDRGs ; o the difference between the maximum and the minimum among the mean case charges of hospitals was greater than 100,000 Won in 94 KDRGs : o the ratio of the maximum and the minimum among the mom LOS of hospitals was greater than 2 in 82 KDRGs ; o the difference between the maximum and the minimum among the mean LOS of hospitals was greater than 3 days in 94 KDRGs. The practice pattern of hospitals explained more than 20% of charge variation in 49 KDRGs and more than 20% of LOS variation in 43 KDRGs. The study results indicated need for a new health policy initiative for cost containment and quality assurance.

• Journal of Preventive Medicine and Public Health
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• v.41 no.1
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• pp.23-29
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• 2008

Objectives : We examined the association between alcohol consumption and incidence of colorectal cancer in elderly Koreans. Methods : The cohort members (n=14,304) consisted of 4,834 males and 9,470 females derived from the Korea Elderly Pharmacoepidemiologic Cohort (KEPEC), a population-based dynamic cohort. They were aged 65 years old or older and lived in Busan between 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). Baseline information was surveyed by a self-administered, mailed questionnaire. This study population was restricted to 14,304 participants who reported alcohol drinking habits on the questionnaire and had not been diagnosed with colorectal cancer at baseline. The adjusted hazard ratios (aHR) of status, type, frequency and daily average amount of alcohol consumption were computed with Cox's proportional hazard model, with the never-drinkers as a reference group and controlling for age and gender. Results : After 4.82 person-years of mean follow-up 112 cases of colorectal cancer occurred. The incidence densities of colorectal cancer were 161 (95% CI=123-200) for never-drinkers, 219 (95% CI=125-339) for ex-drinkers, and 137 (95% CI=84-189) for current-drinkers per 100,000 person-year. The status, type, frequency, and daily average amount of alcohol consumption were not significantly related to the incidence of colorectal cancer after controlling for age and gender. Conclusions : There was no significant association between alcohol consumption and colorectal cancer among elderly people after controlling for age and gender.

• Journal of Preventive Medicine and Public Health
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• v.41 no.1
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• pp.51-60
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• 2008

Objectives : We examined the effect of sociodemographic factors, cancer, and psychiatric disorders on suicide by gender and age-specific patterns in South Korea. Methods : The study is a case-control study. Claim data was obtained from the national health insurance database and national death registration database. The number of people who committed suicide was 11,523, which was matched with a control group consisting of ten times as many people at 115,230 selected from the national health insurance and medical aids beneficiaries. The medical utilization of the case group was one year before death and that of the control group was from July 1,2003 to June 30, 2004. Four variables-address, economic status, presence of a psychiatric disease, and cancer-were used in multiple logistic regression analyses. Results : Living in cities or in rural areas showed a greater risk for suicide than living in a metropolitan city. Low economic status, the presence of a psychiatric disorder, and cancer were also statistically meaningful risk factors for suicide. The three major psychiatric diseases, schizophrenia, alcohol abuse, and bipolar disorder, were meaningful in all age groups, but the scale of the odds ratio differed by the age group. Only the psychiatric disorder variable was meaningful in the adolescent group, whereas a psychiatric disorder and economic status were meaningful for the young adult group, and all variables were meaningful for the middle-aged group. A psychiatric disorder and cancer were meaningful in the elderly group, economic status was meaningful for male subjects, and address was meaningful for female subjects. Conclusions : Factors such as living in city or rural areas, low economic status, the presence of a psychiatric disorder, and cancer were statistically meaningful risk factors in suicide. These factors also differed by age group. Therefore, policymakers should establish policies for suicide prevention that are relevant for each age group.

• Journal of Korean society of Dental Hygiene
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• v.16 no.2
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• pp.195-204
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• 2016

Objectives: The purpose of the study is to investigate the knowledge, attitude, and recognition of health insurance coverage in tooth implant among Korean adults. Methods: A self-reported questionnaire was completed by 420 adults over 20 years lod in Seoul and Gyeonggido from October 1 to December 15, 2014. The questionnaire consisted of general characteristics of the subjects, knowledge, attitude, and recognition of health insurance coverage in tooth implant. Results: The mean of knowledge of regular checkup after implant was 3.05 points, and mean of advantage and disadvantage of implant was 3.03 points. The expectation for the implant treatment was 4.18 points and this was the highest score. There was no significant difference between the knowledge and attitude in age and monthly compensation(p>0.05). Only 45.6% of the adults were aware of the health insurance coverage of tooth implant since July, 2014. Health Insurance meeds to be modified in the beneficiaries age(44.6%), and cost(32.7%). The positive aspects of implant care included medical expenses(37.8%), health care beneficiary(29.1%), and oral health promotion(20.9%). Conclusions: Health insurance coverage of tooth implant is very important to enhance the quality of life in the adults because the proper management and implementation of the health insurance in implant will improve the oral health care in life.

• Health Policy and Management
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• v.24 no.4
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• pp.396-412
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• 2014

Background: As a reform plan of health care system, Accountable Care Organization (ACO) has became an object of attention in the United States after Patient Protection and Affordable Care Act was enacted. ACO is a group of various health care providers and provide coordinated care to its assigned beneficiaries. If ACOs improve the quality level and reduce the cost of care, they can get financial incentives. Under the discussion for a quite long time and demonstration projects, ACO has been established. We aimed to analysis and discuss the history, policy mechanism, contents, status and outcomes of ACO. Also, we intended to suggest political implication Korean health care system with regard to ACO. Methods: We searched the articles related ACO in PubMed and selected several available papers about ACO. Total 56 studies were reviewed and categorized three parts; demonstration projects for formation of ACO, policy mechanism and agenda, empirical results of ACO performance. Results: As a result, establishment of ACO was successful partly in the US. It seems to be due to various project and pilot test for verification in the long time. The empirical effect of ACO was also identified in a few study but it needs more evidences to judge its positive effect. Conclusion: In Korea, there are arguments for the application of ACO. However it is difficult to implement a ACO by different political conditions between Korean and US. Nevertheless ACO proposed us the necessity of paradigm shift in our health policy and could be significant to national policy orientation in the future.

• Korean Journal of Health Education and Promotion
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• v.29 no.5
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• pp.37-48
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• 2012

Objectives: The economic evaluation of health promotion programs has increasingly become an imperative activity for securing public fund or budget. The purpose of this study is to conduct an economic evaluation for the healthy school canteen program using the contingent valuation method(CVM). Methods: To estimate the benefit from the healthy school canteen program, double-bounded dichotomous choice method as a sort of willingness to pay was employed. Four hundred parents who lived in Seoul and have students at middle or high schools, were administrated by semi-constructive questionnaire containing the necessary information for benefit estimation. Cost estimation of healthy school canteen program was made referring to three types of pilot programs. Finally, the benefit against the cost was worked out according to the three levels of estimated cost. Results: Cost estimate is 8,488 and 9,311 won depending on the two senarios about how to invest on the program, respectably. The results of benefit estimate shows that the average cost willingness to pay(WTP) for healthy school canteen program is 21,275 won(16,963-59,838 won, 95% CI) and total benefits turned out 14.7 billion won. According to the cost-benefit analysis, average benefit-cost ratio is from 2.3 to 3.6. Conclusions: Healthy school canteen program could be economically accepted, and government can take consideration of expanding beneficiaries of healthy school canteen program for health promotion.

• Journal of Labour Economics
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• v.41 no.3
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• pp.1-59
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• 2018

The Earned Income Tax Credit (EITC) is a policy that supports low-income households financially as well as provides an economic incentive to participate in the labor market. Thus, estimating the causal effect of the policy on the labor force participation rate of low-income households is critical for the policy evaluation. In this paper, we exploit the variation in the eligibility to the EITC and the size of the benefit over several reforms of the EITC in South Korea since 2008 and estimate the impact on the participation in the labor market. Using data from four major household surveys, we find that the results are mixed; in some samples and specifications, we find that the effect is positive and statistically significant, while it is insignificant in others. The estimated effect is more likely to be positive and significant when we restrict the sample to the period before 2014. It is an important topic of future research whether the EITC's effect gets weaker because it is extended to cover the self-employed and beneficiaries of the National Basic Livelihood Security.

• Journal of Korean Academy of Nursing Administration
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• v.11 no.4
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• pp.401-414
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• 2005

Purpose: This study was to evaluate the utilization of health care service and to provide supportive data for health care policy making in one urban area in Korea. Method: This study tested the significance of public health service using the database of an university hospital and public health center from Feb. 2000 to Dec. 2004. Data were analyzed by multidimensional analysis and data mining technique and produced the information on the classification of utilization characteristics by main disease and the total cost of use and disease association with the users of the public health center. Results: The Results were as follows: 1) Top 10 diseases in the area accounted for 22.4% of total frequency for the most recent 5 years in university hospital, while 59.0% in public health center. 2) There were significant correlations between university hospital and public health center user's insurance type and place of residence: It showed higher use of public health center for free service beneficiaries residing in Seoul than residents in nearby or local area. The medical insurance types for hospital users were more various than those for public health center users. 3) The use of hospital for patients of hypertension, diabetes mellitus and hyperlipidemia was tended to concentrate in mostly autumn and winter since August 2000, while the cost of using public health center for those patients has been steadily reduced since July 2000. 4) As a result of cluster analysis, there were classified into three homogeneous groups according to the total cost of using public health service, age, and the frequency of use. 5) The association analysis on patients with chronic disease in public health center produced a detailed information on accompanying diseases related to the incidence rate of disease of high frequency due to aging, information on drug abuse and immune disease. Conclusion: The health care policy for local community should be evaluated continuously. And the policy to build an integrated data warehousing by public health indicator system and to enhance the faithfulness of data is required.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.6
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• pp.2667-2676
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• 2013

This study was to examine the relationship between suicidal ideation, depression, stress and their parent's socioeconomic status. Nation-wide representative data from the Korean National Health and Nutrition Examination Survey 2009 were used in this study. 904 adolescents with parent were analysed. Parent's socioeconomic status, especially mother's low educational level and the beneficiaries for national basic livelihood security were significant risk factor for adolescents' suicidal ideation. These associations remained significant in multiple logistic regression controlling for all covariates. The findings in the current study support the global literature on the importance of socioeconomic status in promoting adolescent's mental health. Future prevention intervention efforts to improve adolescent's suicide risk will need to take into consideration parent's and household's socioeconomic conditions. Future study is needed to explore the possible proximal risk factors and mediators between parent's socioeconomic status and mental health among adolescents.