• 보건행정학회지
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• 제18권1호
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• pp.1-20
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• 2008

How health care providers compete and how competition among them affects their behavior are crucial questions in theory and health policy. In ordinary markets, competition improves social welfare, However in health care markets facing uncertainty and information asymmetry, competition can take the form of wasteful quality competition and result in cost increase. The purpose of this study is to examine the characteristics of hospital service markets and examine the impact of hospital competition on hospital behavior, more specifically hospital cost and the size of personnel. Based on patient discharge data of 2002 by the Ministry of Health and Welfare and Korea Institute for Health and Social Affairs, and health insurance EDI claims data of 2002, this study measures the degree of competition in the inpatient service market of hospitals, using variable radius method and Herfindahl index. The result of the study shows that the hospital service market consists of on average 3.13 government administrative units(shi, gun, or gu). Compared with hospitals, general or general specialized hospitals cover larger markets and operate in more competitive markets. Nearly 60% of patients use hospitals, which are not located in their government administrative units, meaning that market definition based on variable radius is better than the conventional method of market definition based on government administrative units. The results of multivariate analysis show that competition is not associated with high cost index of hospitals. But hospitals in more competitive markets employ larger(more intensive) input of personnel per 100 beds, implying that hospital competition in Korea can have the form of quality and cost-increasing competition.

• Journal of Preventive Medicine and Public Health
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• 제44권4호
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• pp.167-175
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• 2011

Objective: This study was designed to describe the trends in body mass index (BMI) during 6 years (2002-2008) and to identify associations between these trends and the amount of physical activity of South Korean career soldiers. Method: This study targeted the 40 993 (38 857 men and 2136 women) of the 58 657 career soldiers who had undergone four (2002, 2004, 2006, and 2008) biennial medical examinations conducted by the National Health Insurance Corporation; 17 664 soldiers with missing data on height, weight, and physical activity were excluded. A linear mixedregression model was used to categorize changes in BMI due to age versus those due to amount of physical activity. Results: Career soldiers experienced significant increases in BMI compared with baseline data gathered in 2002. The increases in each age group were as follows: men aged 20-29: 1.16, men aged 30-39: 0.61, men aged 40-49: 0.05, women aged 20-29: 0.35, women aged 30-39: 0.30, women aged 40 -49: 0.26, and women aged 50-59: 0.21. However, men aged 50 or older showed significant decreases (as high as 0.5) in BMI compared with baseline data obtained in 2002. They also experienced significant decreases in BMI compared with those who reported no physical activity. The differences between baseline and final BMIs were: 0.02 for men exercising 1-2 times per week, -0.07 for men exercising 3-4 times per week, -0.19 for men exercising 5-6 times per week, -0.21 for men exercising seven times per week, -0.05 for women exercising 1-2 times per week, -0.19 for women exercising 3-4 times per week, -0.30 for women exercising 5-6 times per week, and -0.30 for women exercising seven times per week. Conclusions: Obesity in South Korean career soldiers increased markedly between 2002 and 2008, and our data showed that the amount of physical activity was inversely related to increases in BMI. Policies to prevent obesity are needed to reduce this trend.

• Communications for Statistical Applications and Methods
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• 제16권2호
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• pp.249-264
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• 2009

지수연동형 보험상품(EIA: Equity-indexed annuities)은 주식시장의 수익률과 연계하여 보험상품의 수익률이 결정되며 주식시장의 수익률이 낮은 경우에도 최소보장 수익률이 제공되는 상품이다 EIA의 수익률은 주가 수익률에 일정 비율을 곱하고 이 값과 최소보장수익률과 비교하여 높은 값을 수익률로 정의한다. 여기서 주가수익률에 곱하는 일정비율을 참여율(Participation rate)이라고 부른다. 본 논문에서는 수익률을 결정하는 주가지수와 일정수준을 넘는 여부를 결정하는 주가지수를 다른 지수로 사용하는 Outside Barrier가 내재된 보험 상품을 제안하고자 한다. 특히 Outside Barrier조건의 결정을 계약기간 전체가 아닌 계약기간의 일부분으로 선정한 것이 특징이다. 이러한 수익률 구조를 반영하는 가격 공식을 기댓값 계산을 통하여 유도하고 수치해석 기법을 이용하여 최소보장이율, Rebate, barrier 수준, 주가 변동성, 상관계수 및 관측기간 등의 변수가 참여율의 결정 에 어떤 영향을 미치는지를 알아보고자 한다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권8호
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• pp.3383-3389
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• 2014

Background: Prostate cancer is rapidly increasing in Korea and professional societies have requested adding prostate specific antigen (PSA) testing to the National Cancer Screening Program (NCSP), but this started a controversy in Korea and neutral evidence on this issue is required more than ever. The purpose of this study was to provide economic evidence to the decision makers of the NCSP. Materials and Methods: A cost-utility analysis was performed on the adoption of PSA screening program among men aged 50-74-years in Korea from the healthcare system perspective. Several data sources were used for the cost-utility analysis, including general health screening data, the Korea Central Cancer Registry, national insurance claims data, and cause of mortality from the National Statistical Office. To solicit the utility index of prostate cancer, a face-to-face interview for typical men aged 40 to 69 was conducted using a Time-Trade Off method. Results: As a result, the increase of effectiveness was estimated to be very low, when adopting PSA screening, and the incremental cost effectiveness ratio (ICER) was analyzed as about 94 million KRW. Sensitivity analyses were performed on the incidence rate, screening rate, cancer stage distribution, utility index, and treatment costs but the results were consistent with the base analysis. Conclusions: Under Korean circumstances with a relatively low incidence rate of prostate cancer, PSA screening is not cost-effective. Therefore, we conclude that adopting national prostate cancer screening would not be beneficial until further evidence is provided in the future.

• 자원ㆍ환경경제연구
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• 제25권4호
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• pp.471-494
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• 2016

본 연구는 1996년부터 2013년의 경제성장률의 변동성 데이터를 이용하여 아프리카 28개국의 경제적 안정성에 영향을 미치는 요인을 분석한 것이다. 28개 아프리카 국가의 1996년 부터 2013년의 연도별 자료를 3년씩 따로 분류하여 총 6개의 시계열 자료를 구축하고 이를 토대로 패널 분석을 수행하였다. 송금 및 농업원조와 경제성장률의 변동성 간의 내생성 문제를 해결하기 위하여 system-GMM (system-Generalized Method of Moments)을 이용하였다. 분석결과 기후변화를 대표하는 요인 중 자연재해와 온도의 변동성만이 경제 안정성을 악화시키는 요인으로 나타났다. 반면 송금과 농업원조자금은 아프리카 국가들의 경제를 안정시키는 효과를 보이며, 특히 송금의 경우 자연재해 발생에 따른 경제 변동성을 감소시키는 보험의 역할을 하는 것으로 판단된다.

• 보건행정학회지
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• 제22권1호
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• pp.85-108
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• 2012

One of the ways to achieve the principle of equal access for equal needs, availability and geographical accessibility of health care resources regardless of resident sites is important. The purpose of this paper is to measure socioeconomic inequities in distribution of health care resources among regions in the Republic of Korea (hereafter Korea). Data were extracted from regional statistics of National Health Insurance, Community Health Survey, Korea Social Science Data Archive, and Korean Statistical Information Services at the same period of 2009. The dependent variables were the number of health workforce and health care facilities in each region. The proxy indicator of regional socioeconomic status was local tax per person. To identify whether inequalities among regions, we examined the concentration index(CI) and indirectly standardized CI by controlling each region's demographics and need factors. Total observations were 232 districts in nationwide, and we analyzed separately Seoul(25 districts) and non-Seoul areas(207 districts). The standardized CI values of health care resources were positive(favoring the rich region) across the nation in almost all kinds of resources. Especially the number of specialist, dentist, dental clinics, clinics, oriental medical clinics, pharmacists, and pharmacies were statistically significantly favoring the rich region. But the CI for the number of long-term care hospitals, public health centers were negative(favoring the poor region). The tendency of CI presenting positive values were increased in Seoul area. But in the case of non-Seoul, the CI indexes were nearly zero. The results suggest that except the Seoul area, little regional socioeconomic-related inequalities were observed in the distribution of health care resources in Korea.

• Journal of Trauma and Injury
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• 제34권1호
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• pp.39-43
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• 2021

Purpose: Determining appropriate ways to assess health care quality within the National Health Insurance System is of interest to both the Korean government and the medical community. However, in the trauma field, the number of indicators used to evaluate surgical quality is limited. Using data collected over 5 years at Wonju Severance Christian Hospital Trauma Center in Korea, this study aimed to determine whether the unplanned reoperation rate in the field of trauma surgery could be used to assess the quality of an institution's surgical care. Methods: In total, 665 general surgical procedures were performed at the Trauma Center in 453 patients with abdominopelvic injuries from January 2015 to December 2019. Data were collected from the Trauma Center's data registry and medical records, and included information regarding patients' demographic characteristics, the type of index operation, and the reason for unplanned reoperations. Results: A total of 453 index operations were evaluated. The proportion of patients with an Injury Severity Score (ISS) >15 was 48-70% over the 5-year period, with an unplanned reoperation rate of 2.1-9.3%. Patients had an average ISS score of 17.5, while the average Abbreviated Injury Scale Score was 2.87. Unplanned reoperations were required in about 7% of patients. The most common complications requiring reoperation were recurrent bleeding (26.9%), wound problems (26.9%), intestinal infarction (15.4%), and anastomosis site leakage (7.7%). The procedures most frequently requiring unplanned reoperations were bowel surgery (segmental resection, primary repair, enterostomy, etc.) (24.5%) and preperitoneal pelvic packing (10.6%). Conclusions: The proportion of reoperations was confirmed to be affected by injury severity.

• Journal of Preventive Medicine and Public Health
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• 제55권4호
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• pp.379-388
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• 2022

Objectives: Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households. Methods: This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP. Results: Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively. Conclusions: In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

• 치위생과학회지
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• 제22권2호
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• pp.67-74
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• 2022

Background: Depression and cognitive function have a positive effect on the improvement of quality of life and extension of lifespan in the elderly. In addition, it appears as a major factor influencing oral health status. Therefore, this study looked at the relationship between the Geriatric Oral Health Assessment Index (GOHAI), depression, and cognitive function in the elderly using the Korea Longitudinal Study of Aging. Methods: In this study, 4,535 elderly people aged 65 years and over were targeted using the 7th data of the 2018 Korea Longitudinal Study of Aging. A t-test and ANOVA analysis were performed to compare GOHAI, depression, and cognitive function by group. In addition, hierarchical multiple linear regression was performed to understand the effect of the elderly's perceived depression scale and cognitive ability on GOHAI. Results: As a result of adding the depression scale and cognitive function variables to Model 2, the explanatory power was 22%. Educational level, marital status, private health insurance subscription, average monthly allowance, subjective health status, use of dentures, smoking status, economic activity, depression scale, and cognitive function were found to have significant influence (p<0.05). In addition, when controlled and viewed with all factors, depression and cognitive function were found to have an effect on oral health-related quality of life. Conclusion: The findings indicate that depression and cognitive function are associated with oral health-related quality of life in the Korean elderly. As the age increases, the quality of life declines due to depression and cognitive function problems, in addition to oral discomfort, eating disorders, and physical discomfort.

• Journal of Preventive Medicine and Public Health
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• 제55권5호
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• pp.475-484
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• 2022

Objectives: This study aimed to determine the association between metabolic syndrome (MetS) and the incidence of colorectal cancer (CRC) in Korean women with obesity. Methods: Cancer-free women (n=6 142 486) aged 40-79 years, who underwent National Health Insurance Service health examinations in 2009 and 2010 were included. The incidence of CRC was followed until 2018. The hazard ratio (HR) of MetS for the incidence of colon and rectal cancer was analyzed according to body mass index (BMI) categories, adjusting for confounders such as women's reproductive factors. In addition, the heterogeneity of associations across BMI categories was assessed. Results: Women with MetS were at increased risk of colon and rectal cancer compared to women without MetS (HR, 1.20; 95% confidence interval [CI], 1.16 to 1.23 and HR,1.15; 95% CI, 1.11 to 1.20), respectively. The HR of MetS for colon cancer across BMI categories was 1.12 (95% CI, 1.06 to 1.19), 1.14 (95% CI, 1.08 to 1.20), and 1.16 (95% CI, 1.12 to 1.21) in women with BMIs <23.0 kg/m², 23.0-24.9 kg/m², and ≥25.0 kg/m², respectively. The HR of MetS for rectal cancer across corresponding BMI categories was 1.16 (95% CI, 1.06 to 1.26), 1.14 (95% CI, 1.05 to 1.23), and 1.13 (95% CI, 1.06 to 1.20). The heterogeneity of associations across BMI categories was not significant in either colon or rectal cancer (p=0.587 for colon cancer and p=0.927 for rectal cancer). Conclusions: Women with MetS were at increased risk of colon and rectal cancer. Clinical and public health strategies should be considered for primary CRC prevention with an emphasis on improving women's metabolic health across all BMI groups.