• The Korean Journal of Applied Statistics
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• v.30 no.3
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• pp.391-401
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• 2017

This study develops an indicator to manage regional variations of approval rates for long-term care (LTC) service. We used LTC insurance data for grade assessment that include 433,155 applicants from 227 LTC centers across Korea in 2015. The approval rate for each center was defined as the proportion of the numbers of approved applicants out of all applicants. We assumed that the approval rates depended on the characteristics of applicants. We estimated the 'standard' approval rates from a multiple linear regression analysis using the characteristics of applicants as independent variables. The difference between the observed and the standard rates was then defined as an indicator for deviation. A center having a large difference could be considered as a center with a potential error in grade assessment. We also examined if the characteristics of investigators affected the approval rates. We found that the socio-demographic characteristics of applicants and reapplication rate for LTC grade were independent factors affecting the approval rates. Centers having the management indicator values falling outside the middle 95% of the distribution were identified as centers with an error in grading. We expect that this study will contribute to enhancing reliability and equity in LTC grading.

• Korean Journal of Health Education and Promotion
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• v.28 no.3
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• pp.31-42
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• 2011

Objectives: Busan had the highest mortality and the shortest life expectancy at birth among 16 provinces in Korea in 2008 and there were considerable health inequalities within the region. This study was performed to build up a priority setting framework in Healthy City Busan project. Methods: Analytic hierarchy process was used to determine the relative priority weight for different strategic and program dimensions along with the consistency of response. An on-site workshop-based meeting (calculating importance) and online survey (calculating risk) were conducted to obtain data from 8 experts. Results: The results showed that in strategic criteria "active health promotion & diseases prevention" and "building infrastructure for the Health City project" were two most important factors. In program criteria, considering both importance and risk scores, "making a healthy community" and "building community health centers" in disadvantaged areas were a top priority group. In addition, "enacting an ordinance for the Healthy City", "building the infrastructure for health impact assessment" and "making health care safety net for vulnerable population" were also higher priorities group. Conclusions: Our findings suggest that the Healthy City project in Busan should be focused on strengthening health equity and building infrastructure for sustainability of the project.

• Journal of Preventive Medicine and Public Health
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• v.22 no.4 s.28
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• pp.578-590
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• 1989

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.

• The Journal of the Korea Contents Association
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• v.17 no.6
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• pp.63-70
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• 2017

Although the National Health Insurance, many people sign up for private health insurance to alleviate their financial burden. In this study, we analyzed the relationship between private health insurance and subjective financial burden about cost sharing. To confirm the effect we conducted the binary logistic regression by utilizing the Health Care Policy related to public survey. The private health insurance have a significantly association with the subjective financial burden about cost sharing. People who uninsured to purchase private health insurance were more likely to have the burden. Therefore, given the low participation rate of private medical insurance for high age and low income group, we suggest the need for redefining the role of private insurance to enhance the function and resolve equity issues to prepare for the burden.

• Journal of The Korean Society of Integrative Medicine
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• v.11 no.4
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• pp.291-298
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• 2023

Purpose : Although Korea's health insurance system and access to medical care are well established compared to other countries, the rate of non-fulfillment of dental treatment is high. Medical use rates can be affected by economic characteristics, individual heatlh condtions, health concerns, and health behaviors. This study was implemented to investigate the effect of the middle-aged elderly people's family living together on the dental examination rate and to use it as basic data for program development, research, and poicies to promote oral health. Methods : Raw data from the 7th national health and nutrition survey conducted by the Korea centers for disease control and prevention (2016~2018) were used and analyzed using SPSS 21.0 Version (IBM, United States). Results : As a result of the study family types accroding to general characteristics, the more women are (p<.001), the higther the age (p<.001), the lower the hosehold income level (p<.001), the lower the educational background (p<.001), the more people who live in Eup-Myeon (p<.001) It was fouend that the rate of living alone was high. The dental examination rate according to general characteristics was related to age (p<.001), income (p<.001), and educational background (p<.001), and the higher the examination rate was in the same (p<.001), and the higher the family living together (p<.001). Factors influencing whether or not dental treatment was not performed were in the following order: household income (p<.001), age (p=.001), and family type (p=.017). Conclusion : The above results confirmed the relationship between family membership and dental examination rates, and measures such as the development and operation of participatory programs to improve public oral health by resolving medical inequality and enhancing health equity, and it is believed that the development of professional manpower and the operation of education and programs for professionals are necessary.

• Journal of agricultural medicine and community health
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• v.48 no.4
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• pp.262-274
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• 2023

Objectives: This study examined the evaluation and potential improvements of 'Integrated Healthcare and Social Welfare service model' based on the experiences of practitioners from institutions participating in the 'Dalgubeol Health Doctor Services' and the service recipients. Methods: Qualitative research was conducted from September to November 2022 in this study, focusing on 4 providers from the dedicated Dalgubeol Health Doctor Services Team, 5 contact partners from affiliated organizations, and 6 service beneficiaries. The data gathered underwent thematic analysis. Results: The evaluation indicated that Dalgubeol Health Doctor Services has proven to be effective in addressing the complex needs of vulnerable populations. By providing integrated services through quick and simple beneficiary selection and resource linkage, it has contributed to the resolution of complex demands, recovery of positive attitudes towards life, and improvement in quality of life for users who have fear the use of medical and welfare services. Dalgubeol Health Doctor Services has established an integrated health care system involving not only public but also private organizations, from the referral agency to the service provider. Centered around Daegu Medical Center and involving five tertiary hospitals, it has established a model that supports treatment appropriate to the severity of the patient, from mild to severe. Conclusions: These findings indicate an enhancement in health equity, achieved through the active identification and subsequent health and welfare issue resolution of individuals marginalized from medical benefits.

• 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.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.6
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• pp.2431-2440
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• 2015

Background: Registry data from four major public hospitals indicate trends in clinical care and survival from colorectal cancer over three decades, from 1980 to 2010. Materials and Methods: Kaplan-Meier productlimit estimates and Cox proportional hazards models were used to investigate disease-specific survival and multiple logistic regression analyses to explore first-round treatment trends. Results: Five-year survivals increased from 48% for 1980-1986 to 63% for 2005-2010 diagnoses. Survival increases applied to each ACPS stage (Australian Clinico-Pathological Stage), and particularly stage C (an increase from 38% to 68%). Risk of death from colorectal cancer halved (hazards ratio: 0.50 (0.45, 0.56)) over the study period after adjusting for age, sex, stage, differentiation, primary sub-site, health administrative region, and measures of socioeconomic status and geographic remoteness. Decreases in stage were not observed. Survivals did not vary by sex or place of residence, suggesting reasonable equity in service access and outcomes. Of staged cases, 91% were treated surgically with lower surgical rates for older ages and more advanced stage. Proportions of surgical cases having adjuvant therapy during primary courses of treatment increased for all stages and were highest for stage C (an increase from 5% in 1980-1986 to 63% for 2005-2010). Radiotherapy was more common for rectal than colonic cases. Proportions of rectal cases receiving radiotherapy increased, particularly for stage C where the increase was from 8% in 1980-1986 to 60% in 2005-2010. The percentage of stage C colorectal cases less than 70 years of age having systemic therapy as part of their first treatment round increased from 3% in 1980-1986 to 81% by 1995-2010. Based on survey data on uptake of adjuvant therapy among those offered this care, it is likely that all these younger patients were offered systemic treatment. Conclusions: We conclude that pronounced increases in survivals from colorectal cancer have occurred at major public hospitals in South Australia due to increases in stage-specific survivals. Use of adjuvant therapies has increased and the patterns of change accord with clinical guideline recommendations. Reasons for sub-optimal use of radiotherapy for rectal cases warrant further investigation, including the potential for limited rural access to impede uptake of treatments at metropolitan-based radiotherapy centres.

• KDI Journal of Economic Policy
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• v.34 no.3
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• pp.31-65
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• 2012

We study the sustainability of the current fiscal policy of Korea, and the effects of the social welfare policy expansion, which has been recently discussed among the political circles, on the government budget and the generational equity, using generational accounting. We follow the generational accounting approach, considering the fact that most of the social welfare policies are the entitlement programs, which imposes the limitation of the policy maker's discretion to control the cost of their provision. The social welfare expenditure will change due to the change in the policy environments of the future, such as population aging. Therefore, we need to take into account the government cash flow of the future as well as of the present to investigate its effects on the fiscal sustainability, which implies that the national debt or the budget balance is not a proper index for the investigation. Our findings are as follows. The current fiscal policies are not sustainable, and the long-term budgetary imbalance is shown very serious. The required tax adjustment, which is defined as the percentage change of tax burden required to attain the long-term budgetary balance, is very large. Unless the level of the government expenditure is properly controlled, the tax burden and the social contribution level will rise to the untolerable level. Moreover, the expansion of the social welfare policies, which has been discussed among the political circles, will substantially increase the fiscal burden of the future generations. Even though the provision of the free lunch to the primary and the secondary school students, the free child care, and the discounted college tuition do not increase the fiscal burden much, because their magnitude at present is not large and will decrease due to the decrease in the number of the newborns and the students resulting from the fall in the fertility rate, that of the free health care service will increase tax burden of the future generations very much, because the magnitude of the government expenditure needed at present is very large and the population aging will further increase the magnitude of the health care expenditure. The findings indicate that the structural reforms, to prevent the explosive increase in the social welfare expenditure in the future, are necessary before the implementation of the welfare policy expansion. In particular, the cost control of the social transfers to the elderly needs to be made, because the speed of the population aging of Korea is among the highest in the world. The findings also indicate that the budget balance or the national debt can cause the fiscal illusion, which makes the Korean government budget look sound, even though the fiscal policy will rapidly increase the social welfare expenditure in the future, as the population ages. The generational accounting, which takes into account the cash flow of the future as well as of the present, unlike the budgetary balance and the national debt, which shows the results of the government financial activities of the past and the present, is a useful method to overcome the fiscal illusion.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.28 no.2
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• pp.116-126
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• 2019

Objectives: Currently, oral health of the disabled is taken care of by the social workers, not by dental hygienists, who are the oral health professional in this area. Therefore, we aim to enhance the equity of oral health for the disabled by providing the correct oral health care method to social workers residing in the welfare facility for the disabled. Methods: Four dental hygienists and four social workers were given the class I intellectual disabilities living in 'o' welfare facilities for disabled people in Songpa-gu, Seoul from April 13, 2019 to April 20, 2019. Patient Hygiene Performance(PHP) Index were measured and compared. In advance, the social workers were taught brushing (Rolling method), and the method of brushing and measuring tools were integrated. Results: Twice a total of dental hygienists and social workers practiced toothbrushing(Rolling method) for the class I intellectual disabilities who is a person to be brushed. When comparing the Patient Hygiene Performance(PHP) Index after the second round, the result shows that both the first and second dental hygienists' Patient Hygiene Performance(PHP) Index is lower. Conclusions: Comparing oral health knowledge level and Patient Hygiene Performance(PHP) index of dental hygienist and social workers, the result shows that dental hygienist has higher oral health care ability. Therefore, the dental hygienist should be placed in welfare facility for the disabled as an expert in oral health management to create an environment in which the disabled and social workers can be trained. In addition, the curriculum of the college that nurtures the dental hygienists should have a course to understand the characteristics of the disabled person in order to enhance the professionalism of dental hygienists.