Background: This study aims to identify the factors that influence the incidence of catastrophic health expenditure (CHE) for the elderly living alone and to discuss how to manage CHE for the elderly living alone. Methods: This study utilizes 6th (2016), 7th (2018), and 8th (2020) data from the Korean Longitudinal Study of Aging to identify the incidence rate of CHE among the elderly living alone and conducts a panel logit analysis. The dependent variable is the incidence of CHE (thresholds: 10%, 20%, 30%), and the independent variables include demographic factors (gender, age group, region), socioeconomic factors (education level, economic activity status, income quintile, financial support rate from children), health-related factors (subjective health status, regular exercise, smoking, drinking, number of chronic diseases), and healthcare coverage factors (type of health insurance, private health insurance). Results: Descriptive statistics classified by gender show that female elderly living alone are more vulnerable than male elderly living alone in terms of disease prevalence and socioeconomic status. In addition, the incidence of CHE is higher for elderly women living alone than for elderly men living alone across all thresholds. The main results of the panel logit analysis show that higher education, income quintile, and financial support rate from children are associated with lower odds of CHE, while poorer subjective health and a higher number of chronic diseases are associated with higher odds of CHE. Medical aid recipients are less likely to incur CHE than those covered by national health insurance. Conclusion: The implications of this study are as follows. First, vulnerable elderly living alone with multiple chronic diseases and low income and education levels are more likely to incur CHE. Second, it is necessary to review policies such as a CHE support program and chronic disease management programs focused on vulnerable elderly individuals living alone. Third, the CHE support program should be operated in a patient-centered manner, with consideration given to a customized system for selecting and supporting elderly individuals living alone who are in need.
This study reviews the advent of long-term care (LTC) hospitals and its key issues in Korea. For analysis, enforcement ordinances and enforcement rules related to LTC hospitals were reviewed. Official statistic data were used for quantitative analysis and Organization for Economic Cooperation and Development data were utilized for comparative analysis. Various references and expert interviews were conducted for status analysis. As of 2016, the number of LTC hospitals was 1,386 and the number of beds were 246,373. It showed the trend of increasing medical care costs and the cost of care at LTC hospitals increasing from 998.8 billion Korean won in 2008 to 4,745.6 billion Korean won in 2016, accounting for 7.3% of the total National Health Insurance expenditure. From the societal perspective, several issues were pointed out within the current health care system related to LTC hospitals: establishment of roles, concerns about the increase in medical expenses, and the quality of medical personnel.
I. Background and Purpose Health Indicator system and measurement of health status are an important fields in national health fields. This study reviewed the overall concepts of health and health indicators, health indicator system. The purposes of this study are to build the conceptual health framework, and suggest a health indicator system, in order to correspond to the situation of national health and the demand of International organizations. II. Scope and Contents The scope of this study ; - Review of tile conceptual health framework, health indicators, and health Indicator system - Selection and development of tile new individual health indicators - Suggestion of tile revised health indicator system III. Results of Study This study intented to build the conceptual and framework of national health and provide the measurement tools of health status. This study developed the health indicator system through the conceptual and hierarchial approach to national health. The health indicator system contains 6 concern: areas and each sub-areas. The major concern areas are health state and behavior, deathㆍdiseaseㆍdisability, health care utilization, health resources, health expenditure and finance, other affecting factors on health. This health indicator system is corresponding to the situation of health status patterns and the demand of international organizations. And this health indicator system is considering the present health data production system and the availability of health data.
This meta-analysis was performed to assess the implementation effects of clinical pathways in patients with gastrointestinal cancer. A comprehensive search was conducted in the Cochrane Library, PubMed, EMBASE, Web of Science and Chinese Biomedical Literature Database (from inception to May 2014). Selection of studies, assessing risk of bias and extracting data were performed by two reviewers independently. Outcomes were analyzed by fixed-effects and random-effects model meta-analysis and reported as mean difference (MD), standardized mean difference (SMD) and odds ratio (OR) with 95% confidence intervals (CI). The Jadad methodological approach was used to assess the quality of included studies and the meta-analysis was conducted with RevMan 5.1 software. Nine citations (eight trials) involving 642 patients were included. The aggregate results showed that a shorter average length of stay [MD = -4.0; 95% CI (-5.1, -2.8); P < 0.00001] was observed with the clinical pathways as compared with the usual care. A reduction in inpatient expenditure [SMD = -1.5; 95% CI (-2.3, -0.7); P = 0.0001] was also associated with clinical pathways, along with higher patient satisfaction [OR = 4.9; 95% CI (2.2, 10.6); P < 0.0001]. Clinical pathways could improve the quality of care in patients with gastrointestinal cancer, as evidenced by a significant reduction in average length of stay, a decrease in inpatient expenditure and an improvement in patient satisfaction. Therefore, indicators and mechanisms within clinical pathways should be a focus in the future.
Park, Yoo-Jin;Kim, Myoung-Hee;Kown, Soon-Man;Shin, Young-Jeon
Journal of Preventive Medicine and Public Health
/
v.42
no.2
/
pp.123-129
/
2009
Objectives : This study aimed to examine the association between public social expenditure(PSE) and suicides in the 27 countries of the Organization for Economic Cooperation and Development(OECD) from 1980 to 2003. Methods : The age-standardized suicide rates and their annual change(%) were obtained from the OECD Health Data 2007. As a measure of social protection, the PSE(% GDP) was used. The covariates included the annual divorce rate(/100,000 population), fertility rate(number of children/woman aged 15 to 49 years), GDP per capita(US$ PPP), male unemployment rate(%), life expectancy(years) and alcohol consumption(liter/capita) for each country, which were all obtained from the OECD Health Data 2007 and the OECD Social Indicators 2006. Using hierarchical linear models that included these covariates, the effects of PSE on suicides(Model 1) and the annual percent change (Model 2) were examined(Model 3). Also, sub-sample analyses were done for six countries that experienced political/economic transition. Results : We could not find significant effects of PSE on suicides(Model 1), but we observed significantly negative effects on the annual percent change for men and women(Model 2). Such findings were replicated in the sub-sample analysis, and moreover, the effect size was much larger(Model 3). Conclusions : Our finding suggests that social welfare protection can be a pivotal factor for suicide epidemiology, and especially in countries experiencing a social crisis or transition.
Objectives: As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods: A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results: The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions: The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.
This study was carried out to assess medical care expenditure of residents in urban poor area. The study population included 377 family members of 85 households in the poor area of Daemyung 8-Dong, Nam-Gu, Taegu and 442 family members of 96 households in a control area. The data was collected through self-administered questionnaires completed by housewives. The survey was conducted from March 1 to May 31, 1992. The mean age was 31.1 years in the poor area and 37.1 years in the control area. The average number of households per house was 4.5 in the poor area and 4.5 in the control area. The frequency of medical care utilization per household in a one month period was 4.6 in the poor area and 4.3 in the control area. The average number of days of utilization was 12.9 in the poor area and 12.5 in the control area. The average monthly income of a househlod in the poor area was 848,600 Won compared to the control area's 1,752,300 Won. The average monthly consumption expenditure of a household in the poor area was 568,800 Won and that in the control area 1,238,400 Won. The average medical care monthly expenditure per household was 34,500 Won in the poor area and 58,400 Won in the control area. The proportion of the medical care expenditure to monthly income and to monthly consumption expenditure was 4.1% and 6.1% respectively in the poor area, and 3.3% and 4.7%, respectively in the control area. The premium of medical insurance was 1.5% in both areas. The proportion of cost for drug was 57.4%, for medical appliance was 1.2%, and for medical treatment was 41.1% in the poor area and in the control area 52.4%, 1.9%, 45.7%, respectively. The highest proportion of medical care expenditures in the poor area was herb clinic utilization (36.9%), while hospital and clinic(37.8%) was the highest proportion in the control area. Mean medical care expenditure per visit was 7,400 Won in the poor area and 12,600 Won in the control area. Mean medical care expinditure per day was 2.800 Won in the poor area and 6,300 Won in the control area.
The purposes of this study were to assess the physical activity level (PAL) and the total daily energy expenditure (TEE) as well as to evaluate the validity of prediction equation for the estimated energy requirement (EER) in normal weight and overweight or obese children and adolescents. The subjects comprised of 100 healthy Korean students aged between 7-18. The anthropometric data was collected. PAL was calculated from the physical activity diary by the 24-hour recall method, and the resting metabolic rate (RMR) was measured by an open-circuit indirect calorimetry using a ventilated hood system. Daily energy expenditure was PAL multiplied by RMR. EER was calculated by using the prediction equation published in KDRIs. There was no significant difference in the means of age and height between the 46 obese subjects and 54 nonobese subjects. The weight and BMI of the obese group (60.2 kg, $25.3kg/m^2$) were significantly higher than those of the nonobese group (42.4 kg, $18.4kg/m^2$). However, PAL was not significantly different between the two groups (nonobese 1.45, obese 1.46). TEE of the obese group (2,212 kcal/day) was significantly higher than that of the nonobese group (1,774 kcal/day). EER (individual PA) and EER (light PA) were significantly higher than TEE (p < 0,001); however, EER (sedentary PA) was not significantly different with TEE in the two groups. These results showed that the levels of physical activity were the same as the sedentary activity both in the nonobese and obese Korean students; moreover, the predictive equation for EER published in KDRI overestimated the TEE of Korean children and adolescents. Therefore, in further research, a new predictive equation for EER should be developed for Korean children and adolescents through the doubly labeled water method.
The National Health Insurance Expenditure has been increased rapidly since the introduction of the separation of prescription and dispensing in 2000, and this trend of rapid growth in overall spendings rate has been observed predominantly among medical practitioners. This study was conducted to investigate the growth rate and distributional changes in private medical practitioners' expenses from 1999 to 2002 and its determinants using the National Health Insurance claims data. The total increasing rate of all medical practitioners' expenditure paid by the National Health Insurance between 1999 and 2002 was $41.71\%$, which exceeding that of general hospitals by $20\%$p. But the income distribution among each practitioner was improved as the changes in Gini coefficient(from 0.40 to 0.38) and decile distribution ratio(from 0.25 to 0.29) during the same period showed. However, this improvement in distributional patterns is not enough since even in 2002 it turned out that the highest $10\%$ income group earned 33times more than the lowest $10\%$ income group did. Also, higher Gini coefficient was observed in larger cities and some department like plastic surgery, obstetrics and gynecology. The major causes of this differentials in medical practitioners' expenses were factors related to medical demand like proportion of old population, residential economic status in a given area. In addition, providers' economic incentives also played an important role in determining their income distribution. The large income differentials among physicians may imply a skewed distribution of patients and thus long waiting time, inefficient utilization of resources and potential inadequate quality of care. In this sense, unreasonable distributional gaps should be reduced, so effective measures as well as ongoing monitoring would be necessary to correct current distributional problems.
Assuming that we introduced integration of medical insurance society for self-employed, this study was conducted to examine effects and results after the integration and to research more effective method for integration. To assess effects and results of the finacial status of 266 insurance societies after intergration, the data were obtained from "The Medical Insurance Program for Self-Employeds Statistical Yearbook in 1992". The major finding are as follows : 1. Three alternative integration proposals were made. First alternative proposal was consisted of 232 medical insurance societies, second was 187, and third was 115. 2. As the results of average number of the insured per insurance societies of medical insurance program for self-employed every alternative proposal, first was 88, 119 persons, second was 108, 576, and third was 178, 967 from 76, 576 persons of present socienties. 3. It was true that the more average size of societies increased, the more average administration expenditure per 1, 000 insured reduced. 4. The average size of societies grew bigger, the rate of general expenditure to general revenue more improved. Also, the rate of benefits to contributions was changed for better. But if not to have had correct analysis and precise preparation for integration, effects and results of integration were always not optiized. 5. According to results of simple regression formulas, it was proved that the more the average size of societies was increased, the more result was advantaged. 6. The law of majority and the economy of scale were applied in this study, and it was necessary to analyze and assess effectiveness and efficiency of integration. Therefore, when the integration of medical insurance societies for self-employeds will be performed, it must be taken into consideration. Among three alternative proposals, third was showed more effective alternative than anothe, second was presented more ineffective result than present system. To achieve more effective and efficient integration of regional medical insurance societies throughout the result of the regression formula on present cost curve, it is necessary to operate well-integrated societies and to know appropriative countermeasures of present situation of each societies. Also, for integrating regional medical insurance societies, it is necessary to continue more deep research through practical model activity and to investigate the effective size and managed method of the societies.societies.
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