• Journal of Korean Medical Science
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• v.33 no.53
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• pp.343.1-343.8
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• 2018

Background: Linkage of public healthcare data is useful in stroke research because patients may visit different sectors of the health system before, during, and after stroke. Therefore, we aimed to establish high-quality big data on stroke in Korea by linking acute stroke registry and national health claim databases. Methods: Acute stroke patients (n = 65,311) with claim data suitable for linkage were included in the Clinical Research Center for Stroke (CRCS) registry during 2006-2014. We linked the CRCS registry with national health claim databases in the Health Insurance Review and Assessment Service (HIRA). Linkage was performed using 6 common variables: birth date, gender, provider identification, receiving year and number, and statement serial number in the benefit claim statement. For matched records, linkage accuracy was evaluated using differences between hospital visiting date in the CRCS registry and the commencement date for health insurance care in HIRA. Results: Of 65,311 CRCS cases, 64,634 were matched to HIRA cases (match rate, 99.0%). The proportion of true matches was 94.4% (n = 61,017) in the matched data. Among true matches (mean age 66.4 years; men 58.4%), the median National Institutes of Health Stroke Scale score was 3 (interquartile range 1-7). When comparing baseline characteristics between true matches and false matches, no substantial difference was observed for any variable. Conclusion: We could establish big data on stroke by linking CRCS registry and HIRA records, using claims data without personal identifiers. We plan to conduct national stroke research and improve stroke care using the linked big database.

• Health Policy and Management
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• v.31 no.3
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• pp.272-279
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• 2021

Background: Korea's health screening program has been faced the need for changes as the population and diseases structure are changing. In addition to Korea, many countries operate state-led health check-up programs to improve the health level of the people, and the operating methods of the program appear in various forms according to each country's health insurance system. This study examines other state-led health screening programs and proposes a direction for the development of Korea's health screening program. Methods: The study was conducted using the literature review method, and the "country" was set as a unit for the case analysis. The operating method of the health screening programs and the financial resources were compared according to the health insurance system. Five countries were selected as Korea, the United States, the United Kingdom, Japan, and Taiwan. Results: The analyzed countries mainly operate the health screening program as a management method for chronic diseases, but there were differences in the operating method, financing, and targeted subjects and examination items. In most countries, a risk assessment was performed prior to the examination (screening), and the subjects who needed the examination were first selected, and a follow-up management service was provided in accordance with the risk each individual exposed. Conclusion: Rather than applying the same screening method to populations with different risk levels, a health screening program will be constructed in consideration of the individual's health level and exposure risk, and the healthcare delivery system will be reorganized so that screening and treatment services can be linked.

• Journal of muscle and joint health
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• v.29 no.1
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• pp.41-49
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• 2022

Purpose: The purpose of this study was to assess the influence of nurses staffing level on patient health outcomes in intensive care units (ICUs) in Korea. Methods: The study was retrospective in nature. Information on patients and their outcomes, as well as nurse cohort data, were obtained from Korea's National Health Insurance Service Database. The observation period was from January 1, 2008 to December 31, 2018, and data for 2,964,991 patients were analyzed. Independent variables included patient' age and sex and hospital type, intensivist, and nurses staffing level. Results: The mortality rate in ICUs was significantly higher at tertiary hospitals with a level 3~4 (HR, 1.21; 95% confidence interval, 1.19~1.22) or level 5~9 nurse staffing (HR, 1.31; 95% confidence interval, 1.27~1.34) compare to that of tertiary hospitals with a 1~2 level. 28-day mortality rate was also higher at general hospitals with a level 3~4 (HR, 1.13; 95% confidence interval, 1.12~1.14), level 5~6 (HR. 1.34; 95% confidence interval, 1.32~1.36), level 7~9 nurse staffing (HR, 1.38; 95% confidence interval, 1.38~1.42), using level 1~2 as reference. Conclusion: Nurses staffing level is a key determinant of healthcare-associated mortality in critically ICUs patients. Policies to achieve adequate nurse staffing levels are therefore required to enhance patient outcomes.

• Journal of Preventive Medicine and Public Health
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• v.56 no.6
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• pp.563-572
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• 2023

Objectives: The high readmission rate of patients with chronic obstructive pulmonary disease (COPD) has led to the worldwide establishment of proactive measures for identifying and mitigating readmissions. This study aimed to identify factors associated with readmission, as well as groups particularly vulnerable to readmission that require transitional care services. Methods: To apply transitional care services that are compatible with Korea's circumstances, targeted groups that are particularly vulnerable to readmission should be identified. Therefore, using the National Health Insurance Service's Senior Cohort database, we analyzed data from 4874 patients who were first hospitalized with COPD from 2009 to 2019 to define and analyze readmissions within 30 days after discharge. Logistic regression analysis was performed to determine factors correlated with readmission within 30 days. Results: The likelihood of readmission was associated with older age (for individuals in their 80s vs. those in their 50s: odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19 to 2.12), medical insurance type (for workplace subscribers vs. local subscribers: OR, 0.84; 95% CI, 0.72 to 0.99), type of hospital (those with 300 beds or more vs. fewer beds: OR, 0.77; 95% CI, 0.66 to 0.90), and healthcare organization location (provincial areas vs. the capital area: OR, 1.66; 95% CI, 1.14 to 2.41). Conclusions: Older patients, patients holding a local subscriber insurance qualification, individuals admitted to hospitals with fewer than 300 beds, and those admitted to provincial hospitals are suggested to be higher-priority for transitional care services.

• Dementia and Neurocognitive Disorders
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• v.22 no.4
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• pp.121-129
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• 2023

Background and Purpose: As it becomes an aging society, interest in senile diseases is increasing. Alzheimer's dementia (AD) and osteoporosis are representative senile diseases. Various studies have reported that AD and osteoporosis share many risk factors that affect each other's incidence. This aimed to determine if active medication treatment of AD could affect the development of osteoporosis. Methods: The Health Insurance Review and Assessment Service provided data consisting of diagnosis, demographics, prescription drug, procedures, medical materials, and healthcare resources. In this study, data of all AD patients in South Korea who were registered under the national health insurance system were obtained. The cohort underwent conversion to an Observational Medical Outcomes Partnership-Common Data Model version 5 format. Results: This study included 11,355 individuals in the good persistent group and an equal number of 11,355 individuals in the poor persistent group from the National Health Claims database for AD drug treatment. In primary analysis, the risk of osteoporosis was significantly higher in the poor persistence group than in the good persistence group (hazard ratio, 1.20 [95% confidence interval, 1.09-1.32]; p<0.001). Conclusions: We found that the good persistence group treated with anti-dementia drugs for AD was associated with a significant lower risk of osteoporosis in this nationwide study. Further studies are needed to clarify the pathophysiological link in patients with two chronic diseases.

• Health Policy and Management
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• v.29 no.4
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• pp.382-393
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• 2019

The right to petition is a classical right of the people in constitutional states, and in Korea, it is a statutory right in the Constitution, the National Assembly Law, the Petition Law, and the Local Autonomy Act. The healthcare community first made a successful petition to the National Assembly when it achieved the amendment of the Government Organization Act through a petition to the National Assembly for the independence of the Ministry of Health, and this achievement served as the basis for further petitions. Since then, the healthcare community has successfully achieved the enactment and amendment of related occupational laws through National Assembly petitions, such as the amendment of Article 41, Paragraph 7 of the former Medical Insurance Act (Korean Medical Association, 14th Assembly), enactment of the Dental Health Act (Korean Dental Association, 15th Assembly), and amendment of the Health Functional Foods Act (Korea Pharmaceutical Association, 16th Assembly). Its petition accomplishment rate is higher than the total petition accomplishment rate of the Health and Welfare Committee of the National Assembly. However, along with the overall decrease in the number of National Assembly petitions, the Korean Medical Association and Korea Pharmaceutical Association have not achieved any results through petitioning since the 16th Assembly (June 2000), and the Korean Hospital Association and Korean Nurses Association have not achieved any results through petitioning since the 17th Assembly (April 2004). Furthermore, no National Assembly petitions have been made at all for 5 years (2014-2018). The Korean Medical Association and Korea Pharmaceutical Association previously showed a high petition accomplishment rate through their accumulated experience with National Assembly petitions and vigorous policy assistance from doctors/pharmacists/nurses turned lawmakers. More specifically, healthcare organizations have achieved results by actively conducting organized activities with the National Assembly, as implemented by a national assembly director and employees, and in case of petitions for legislation, each group has established infrastructure for reviewing the relevant laws by appointing a legislative director, as well as a legal advisor and advisory counsel. Although the organization that has submitted the most petitions to the National Assembly is the Korean Hospital Association, the group with the highest petition success rate is the Korean Medical Association, which may be linked to the relatively high proportion of doctors who have become lawmakers. Furthermore, the fact that other healthcare organizations were highly interested in petitioning the National Assembly has had major implications for the petition activities of healthcare organizations.

• Health Policy and Management
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• v.21 no.3
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• pp.457-492
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• 2011

The primary goal of our study was to investigate the vast transformations of the healthcare sector in Korea during the past half century. Official data reported in the Korean statistical yearbooks and secondary data suggested by previous studies were used for institutional analysis of healthcare environment. Information on hospital released by the Korean Hospital Association was also used for ecological analysis. Institutional analysis: We identified three distinctive eras based primarily on changes in institutional logics, institutional actors, and governance structures : 'professional dominance (1952-1976)', 'government involvement (1977-1999)', and 'coexistence of competing institutional logics (2000-present)'. During the first era, physician association supported by Korean government comprised the primary governance regime. During the second era, the government became a major actor as a regulator and purchaser in health care sector, introducing of the 'mandatory national health insurance'. During the third era, making healthcare system sustainable and providing health care efficiently was overarching goals although it was hard to find a single central logic dominating this period. Ecological analysis: Evidence from the analysis of hospital population suggested that the expansion of the bed capacity was made from different processes, shifting from the ecological process in 1980s to the adaptive process in 1990s. And Korean hospitals had changed following both 'directional process' and 'stabilizing process' over time. Based on our results, we concluded that more studies to compare more organizational populations other than hospitals and to empirically test the effects of institutional changes on organizational changes and vice-versa, need to be conducted.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.2
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• pp.470-478
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• 2020

In this paper, a theoretical model that separates one single conversion factor into two conversion factors for both outpatients and inpatients is introduced. By using hypothetical numbers, two conversion factors and an adjustment factor were calculated. The major implications are as follows. Firstly, by introducing two conversion factors, a minimum incentive mechanism for admitting outpatients to a clinic and high risk inpatients to a hospital was installed. Secondly, the introduction of two conversion factors decreased the drive to admit outpatients to a hospital by reducing the economic benefits for the hospital. Thirdly, it is possible to make explicit contracts for several factors rather than a single conversion factor, so that it can be used as an appropriate management tool for rapidly increasing medical expenses. Finally, this research can be used to set up policy tools to establish a proper healthcare delivery system in Korea by inducing behavioral changes in healthcare institutions.

• Clinical and Experimental Pediatrics
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• v.60 no.5
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• pp.138-144
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• 2017

Purpose: Following legal reform in 2013, the annual number of asylum seekers entering South Korea has increased from 1,143 in 2012 to 5,711 in 2015. We interviewed six African refugee mothers of young children regarding their health needs and barriers to access maternal child health services. Methods: We recruited mothers who had visited a clinic for immigrants between July 2013 and August 2015. Participants were African refugee women, aged over 18 years, who had given birth in Korea within the previous 5 years and had come to Korea over a year before recruitment. Interview questions examined participants' experiences in pregnancy and childbirth and concerns regarding their child's health status. Initial data analysis involved all researchers' immersion in the entire collection of transcripts. We then noted recurrent topics and themes and identified similar issues. Results: At the time of giving birth, 5 participants were asylum seekers and one had undocumented status. The following barriers impeded their access to maternal child healthcare: socioeconomic factors (unstable social identity, low economic status, difficulty obtaining health insurance), language barriers (lack of linguistically appropriate health information, limited access to translation services), and cultural barriers (religious and cultural differences). Weak social support also hindered access to healthcare soon after migration; however, social links with the community emerged as a key coping strategy following settlement. Conclusion: We identified barriers to maternal and child healthcare and coping strategies among African refugee mothers in Korea. Future research should assess refugees' health status and improve health access and literacy among refugee mothers.

• Korea Journal of Hospital Management
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• v.9 no.2
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• pp.128-148
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• 2004

Both undergraduate and graduate programs in health services management(HSM) are recently established in colleges and universities in Korea, and the programs train their students for diverse sectors within the field of healthcare management, including hospitals, nursing facilities, consulting firms, health industries such as pharmaceutical, insurance companies, etc. This study investigates many of the managerial roles expected to graduates from academic curricula in HSM, and required competencies to be successful in their positions. The information of roles and competencies for HSM graduates were collected, and their importances were evaluated by healthcare management experts through a Delphi method. As the result, 11 items for present roles and 13 items for future roles were derived, and 15 and 16 items were derived for present and future competencies respectively. Utilizing the classification of work roles by Timmreck and that of managerial competencies by Robbins, the importance of roles and competencies of healthcare managers was analyzed and interpreted. The major domains of roles at present turned out to be 'organizer', 'planner', 'problem solver', and 'coordinator' in order according to importance. On the other hand, as graduates develop their careers, the domains of future roles would be changed to 'director' and 'planner'. For competencies, the most important domain at present was 'technical skill', but the future important domain was 'interpersonal and emotional intelligence'. The result of this study can be seen as an initial step toward improving the academic curricula of HSM in college and universities and promoting collaborative efforts between academic programs and on-site practices in healthcare industries.