• Journal of Preventive Medicine and Public Health
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• 제56권6호
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• pp.515-522
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• 2023

Objectives: The pandemic caused by coronavirus disease 2019 (COVID-19) has exerted an unprecedented impact on the health of populations worldwide. However, the adverse health consequences of the pandemic in terms of infection and mortality rates have varied across countries. In this study, we investigate whether COVID-19 mortality rates across a group of developed nations are associated with characteristics of their healthcare systems, beyond the differential policy responses in those countries. Methods: To achieve the study objective, we distinguished healthcare systems based on the extent of healthcare decommodification. Using available daily data from 2020, 2021, and 2022, we applied quantile regression with non-additive fixed effects to estimate mortality rates across quantiles. Our analysis began prior to vaccine development (in 2020) and continued after the vaccines were introduced (throughout 2021 and part of 2022). Results: The findings indicate that higher testing rates, coupled with more stringent containment and public health measures, had a significant negative impact on the death rate in both pre-vaccination and post-vaccination models. The data from the post-vaccination model demonstrate that higher vaccination rates were associated with significant decreases in fatalities. Additionally, our research indicates that countries with healthcare systems characterized by high and medium levels of decommodification experienced lower mortality rates than those with healthcare systems involving low decommodification. Conclusions: The results of this study indicate that stronger public health infrastructure and more inclusive social protections have mitigated the severity of the pandemic's adverse health impacts, more so than emergency containment measures and social restrictions.

• Obstetrics & gynecology science
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• 제61권6호
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• pp.662-668
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• 2018

Objective This study was to identify the risk factors for cytological progression in women with atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL). Methods We analyzed data from women infected with the human papillomavirus (HPV) who participated in the Korean HPV cohort study. The cohort recruited women aged 20-60 years with abnormal cervical cytology (ASC-US or LSIL) from April 2010. All women were followed-up at every 6-month intervals with cervical cytology and HPV DNA testing. Results Of the 1,158 women included, 654 (56.5%) and 504 (43.5%) women showed ASC-US and LSIL, respectively. At the time of enrollment, 143 women tested positive for HPV 16 (85 single and 58 multiple infections). Cervical cytology performed in the HPV 16-positive women showed progression in 27%, no change in 23%, and regression in 50% of the women at the six-month follow-up. The progression rate associated with HPV 16 infection was higher than that with infection caused by other HPV types (relative risk [RR], 1.75; 95% confidence interval [CI], 1.08-2.84; P=0.028). The cytological progression rate in women with persistent HPV 16 infection was higher than that in women with incidental or cleared infections (P<0.001). Logistic regression analysis showed a significant relationship between cigarette smoking and cytological progression (RR, 4.15; 95% CI, 1.01-17.00). Conclusion The cytological progression rate in HPV 16-positive women with ASC-US or LSIL is higher than that in women infected with other HPV types. Additionally, cigarette smoking may play a role in cytological progression.

• 보건행정학회지
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• 제32권1호
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• pp.94-106
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• 2022

Background: The efforts to build more "people centered," "patient centered" health system has been emerging all over the world. Aligning with it, the Korean government is conducing the survey called "Medical Service Experience Survey (MSES)." There are critics, however, that MSES is not scrutinizing the medical experiences of patients in various healthcare settings. For this reason, this study aims to perform an empirical analysis of the differences in answers of patients responding to various healthcare settings. Methods: There are two steps in this study. First, explanatory analysis is conducted to compare the tendency of statistical concentration on questionnaires by divided healthcare settings. Second, confirmative analysis is carried out to evaluate the construct validity, reliability, and discriminant validity of the questionnaire in each healthcare setting. The raw data of MSES, which was conducted in 2020 by the Ministry of Health and Welfare in Korea and the Korean Institute for Health and Social Affairs is used. Results: As a result of exploratory factor analysis for all outpatients, the items were classified into four factors statistically: "doctor experience," "nurse experience," "outpatient service experience," and "patient satisfaction." It was confirmed that the reliability of all factors extracted was secured. However, for patients who visited hospitals, questionnaires related to personal privacy, such as "experiences on medical staffs considering physical exposure" or "experiences related to personal information exposure," were answered in conjunction with items of "nurse experience." Besides, patients responded that administrative elements of medical services, such as "experiences of comfort in medical institutions" and "experiences of satisfactory administrative services," were related to the items of "nurse experience." The answers of patients who visited traditional medical hospitals and clinics about "doctor experience" and "nurse experience" were not discerned statistically, and the answers to "doctor experience," "nurse experience," and "medical institution experience" were entangled with the responses of patients who visited dental hospitals and clinics. On the other hand, as a result of the confirmatory factor analysis, it was found that the inquiries of MSES generally had intensive validity. Conclusion: The collection of objective and scientific data is the prominent component to enlighten the patient-centered healthcare system alongside with change of the worldwide paradigm of measuring the healthcare system performance as follows the transition of perspective of health care from provider-centered to patient-centered. This study empirically shows that the patient experience can vary as the healthcare settings. Furthermore, to make an advance in measuring the experience of patients with medical services, this article proposes the deliberate consideration of the different kinds of healthcare settings and articulate design of the survey.

• 가족자원경영과 정책
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• 제26권3호
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• pp.49-64
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• 2022

이 연구는 우리나라 노인들을 의료취약성 정도에 따라 네 집단으로 세분화하여 경제적, 비경제적 사유로 인한 미충족의료 경험 차이를 분석하고, 이에 따른 정책적 시사점을 도출하였다. 2018년 한국의료패널 자료를 사용하였으며, 65세 이상 노인 4,147명에 대해 분석을 실시하였다. 노인들을 세분화한 결과, 일반건강보험가입자가 79.6%, 비수급빈곤층이 13.6%, 차상위경감대상자가 1.1%, 의료급여수급자가 5.7%의 비율을 차지하였다. 분석결과에 따르면, 병의원 또는 치과진료에 대해 노인들의 12.6%는 경제적 사유로, 10.6%는 비경제적 사유로 미충족의료를 경험한 것으로 나타났다. 의료취약계층 노인의 미충족의료 경험률은 비취약계층인 일반건강보험가입자에 비해 전반적으로 높았는데, 이는 대부분 경제적 사유에 따른 경험률 차이에서 비롯된 것이었다. 경제적인 사유로 인한 미충족의료 경험률은 일반건강보험가입자가 9.8%였던 반면, 비수급빈곤층은 18.9%, 차상위경감대상자는 40.0%, 의료급여수급자는 31.5%로 큰 차이가 있었다. 다른 영향요인을 통제한 로지스틱 분석 결과, 모든 의료취약계층이 일반건강보험가입자에 비해 경제적 사유로 미충족의료를 경험할 확률이 유의하게 높았는데, 비수급빈곤층은 약 1.4배, 차상위경감대상자는 3.3배, 의료급여수급자는 2.4배 높아졌다. 반면, 비경제적 사유로 인한 경험은 일반건강보험가입자 대비 의료급여수급자의 경우에만 1.7배 증가하였고, 다른 집단에서는 유의한 차이가 없었다. 이를 바탕으로 본 연구는 의료취약계층 노인들의 필수적 의료자원 보장을 위한 정책적 시사점을 제시하였다.

• 보건행정학회지
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• 제34권1호
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• pp.1-3
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• 2024

최근 필수의료에 대한 접근성 문제가 중요한 사회적 현안이 되고 있다. 정부는 필수의료 제공체계를 강화하기 위해 '필수의료 정책 패키지'를 종합적 대안으로 제시하고 2028년까지 10조 원 이상의 재원을 투입하겠다고 천명하였다. 의료체계의 틀을 바꾸는 중요한 내용을 담고 있는 만큼, 정책 추진 시 고려해야 할 몇 가지 논점을 제시하고자 한다. 첫째, 의사인력양성시스템 설계 시 정쟁화를 막는 기전이 강구되어야 한다. 둘째, 전공의 의존도를 줄이고 전문의 중심 병원으로 전환하는 것은 전공의 양성비용을 사회가 부담하는 한편, 전문의 서비스에 대한 대가로 고비용을 지불한다는 것을 의미한다. 이러한 변화로 인한 비용을 사회가 지불할 용의가 있는지를 숙고하고 적절하게 예산이 마련되어야 한다. 셋째, 세부 정책수단들 중 공유형 진료체계나 지역네트워크사업 등은 개념적 논의 수준에 있기 때문에 다양한 쟁점들이 내실 있게 검토되어야 하며, 국내 의료체계의 여건에 적합하도록 중장기적으로 검토해갈 필요가 있다.

• 디지털융복합연구
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• 제11권12호
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• pp.339-344
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• 2013

최근 만성질환자의 증가로 생활 속에서 건강관리의 중요성이 증대되고 있다. 일상생활 중에 사용자에 의해서 측정된 생체신호가 특정 건강관리 디바이스에 의해서 자동으로 건강관리센터의 서버에 전송된다면 환자의 건강증대 및 건강관리 서비스의 확산에 기여할 것으로 예상된다. 본 논문에서는 사용자가 휴대 가능한 포터블 헬스케어 게이트웨이(Portable Healthcare Gateway)를 개발한다. 본 게이트웨이는 USB형으로 설계되고 표준화된 데이터 전송이 가능하여 사용자의 위치 및 PHD(Personal Health Device)에 제약을 받지 않고 데이터 전송이 가능하다. 개발된 포터블 헬스케어 게이트웨이는 유비쿼터스 환경에서 고객의 건강을 증진시킬 수 있는 효과적인 서비스를 제공한다.

• 보건행정학회지
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• 제33권3호
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• pp.325-337
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• 2023

Background: While there are many studies estimating the effects of private health insurance on various types of health care utilization, few have examined how such effects change in conjunction with important policy reforms in national health insurance (NHI). This study examined how the effect of private health insurance (supplemental and fixed cash benefit) on high-cost outpatient imaging test utilization changed following the expansion of magnetic resonance imaging (MRI) coverage in 2018, which is a key example of the NHI benefit expansion policy in recent years. Methods: Data from the 2017 and 2019 Korea Health Panel Survey, which contained information about healthcare utilization before and after the expansion of MRI coverage in 2018, were used. The incremental effect of private health insurance on high-cost outpatient imaging test utilization for each period were quantified and compared, with special attention given to the type of private health insurance. Results: While people with supplemental private health insurance were more likely to use high-cost outpatient imaging tests than those without, both before and after the expansion of MRI coverage, the incremental effect increased from 1.6% points in 2017 to 2.5% points in 2019. Conclusion: Benefit expansion in NHI does not necessarily reduce disparities in the use of health care between private health insurance subscribers and non-subscribers. The results of our study also suggest that the path through which private health insurance affects healthcare utilization may not be limited to the price mechanism alone but can be more complex.

• 보건행정학회지
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• 제14권3호
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• pp.1-19
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• 2004

The purposes of this study were to investigate factors of the Obstetrics & Gynecology healthcare consumers' selection of hospitals by lifestyle segmentation and to propose managerial suggestions in health care marketing. Out of total 400 Questionnaires, 351 were considered to be valid for final analysis. The Questionnaire consisted of 81 Questions. 11 demographic Questions, 15 factors for selecting hospitals, 55 lifestyle. The collected data were analyzed with SPSS/pc+ Version 10.0. The subjects were divided into four groups in terms of their lifestyles: 'health active group', 'health conscious group', 'health indifferent group', 'health inactive group'. The analysis of factors related to the selection of hospitals shows that there were four factors: 'accessability', 'medical trust', 'cost and convenience', 'facilities'. Conclusion: As a results of this study, 4 types of healthcare consumers' lifestyle were defined. Each life style has specific characteristics. 'Health active group' pursue 'accessability', 'medical trust', 'cost and convenience' and Health conscious group' depended on 'medical trust', 'cost and convenience'. and 'facilities'. 'Health indifferent group' didn't show any special interest in the selection of hospitals and that 'Health inactive group' relied on 'medical trust', and 'facilities'.

• 보건행정학회지
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• 제30권1호
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• pp.62-71
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• 2020

Background: The purpose of this study is to analyze the current status and factors of elderly patients' hospitalization for hip replacement, knee replacement, and general spine surgery. Methods: National health insurance data in 2018 was provided by the National Health Insurance Service. We used multiple regression to analyze factors associated with the medical utilization of hip replacement, knee replacement, and general spine surgery in elderly patients over 65 years old. The dependent variables are the length of stay and total health expenditure. The independent variables are the demographic-social factors (sex, age, region, insurance type, income level) and surgery-related factors (institution type, location of the hospital, surgery classification). Results: The most common factor affecting surgery was the location of medical institutions. Compared with the medical institutions located in metropolitan, the length of stay in rural medical institutions was higher and total health expenditure was lower. The lower quartile of income, the higher the length of stay and total health expenditure. In addition, the variables of age, type of health insurance, and type of medical institution were statistically significant. Conclusion: In this study, we confirmed the effect of sociodemographic factors and medical institution factors on the Healthcare Utilization of spinal and joint surgery.

• Journal of Information Technology Applications and Management
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• 제25권4호
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• pp.185-196
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• 2018

This study investigates the social network among authors to improve the quality of Panel researches. Korea Health Panel (KHP), implemented by the collaborative work between KIHASA (Korea Institute for Health and Social Affairs) and NHIC (National Health Insurance Service) since 2008, provides a critical infrastructure for policy making and management for insurance system and healthcare service. Using bibliographic data extracted from academic databases, eighty articles were extracted in domestic and international journals from 2008 to 2014, April. Data were analyzed by NetMiner 4.0, social network analysis software, to identify the extent to which authors are involved in healthcare use research and the patterns of collaboration between them. Analysis reveals that most authors publish a very small number of articles and collaborate within tightly knit circles. Centrality measures confirm these findings by revealing that only a small percentage of the authors are structurally dominant, and influence the flow of communication among others. It leads to the discovery of dependencies between the elements of the co-author network such as affiliates in health panel communities. Based on these findings, we recommend that Korea Health Panel could benefit from cultivating a wider base of influential authors and promoting broader collaborations.