• Archives of Craniofacial Surgery
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• v.22 no.5
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• pp.254-259
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• 2021

Background: Prophylactic antibiotics are commonly used in craniofacial surgeries. Despite the low risk of surgical site infection after nasal surgery, a lack of consensus regarding the use of antibiotic prophylaxis in the closed reduction of nasal bone fractures has led to inappropriate prescribing patterns. Through this study, we aimed to investigate the status of prophylactic antibiotic use in closed reductions of nasal bone fractures in Korea. Methods: This retrospective cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort of Korea from 2005 to 2015. We analyzed the medical records of patients who underwent closed reduction of nasal bone fractures. The sex, age, region of residence, comorbidities, and socioeconomic variables of the patients were collected from the database. Factors that affect the prescription of perioperative antibiotics were evaluated using multivariate logistic regression analysis. Results: A total of 3,678 patients (mean±standard deviation of age, 28.7±14.9 years; 2,850 men [77.5%]; 828 women [22.5%]) were included in this study. The rate of antibiotic prescription during the perioperative period was 51.4%. Approximately 68.8% of prescriptions were written for patients who had received general anesthesia. The odds of perioperative prophylactic antibiotic use were significantly higher in patients who received general anesthesia than who received local anesthesia (odds ratio, 1.59). No difference was found in terms of patient age and physician specialty. Second-generation cephalosporins were the most commonly prescribed antibiotic (45.3%), followed by third- and first-generation cephalosporins (20.3% and 18.8%, respectively). In contrast, lincomycin derivatives and aminoglycosides were not prescribed. Conclusion: The findings of this study showed that there was a wide variety of perioperative antibiotic prescription patterns used in nasal bone surgeries. Evidence-based guidance regarding the prescribing of antimicrobial agents for the closed reduction of nasal bone fractures should be considered in future research.

• Health Policy and Management
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• v.29 no.2
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• pp.184-194
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• 2019

Background: The extent of coverage rate of the public health insurance is still insufficient to meet healthcare needs. Private health insurance (PHI) plays a role to supplement coverage level of national health insurance in Korea. It is expected that reduce unmet need healthcare. This study was aimed to identify relationship between PHI type and the unmet healthcare need and its associated factors. Methods: Data were obtained from the 2014 Korea Health Panel Survey using nationally representative sample was analyzed. Respondents were 8,667 who were adults over 20 years covered by PHI but have not changed their contract. According to the enrollment form, PHI was classified into three types: fixed-benefit, indemnity, and mixed-type. To identify factors associated with unmet needs, multiple logistic regression conducted using the Andersen model factors, which are predisposing factors, enabling factors, and need factors. Results: Our analysis found that subjects who had PHI with mixed-type were less likely to experience unmet health care needs compared than those who did not have it (odds ratio, 0.80; 95% confidence interval, 0.66-0.98). As a result of analyzing what affected their unmet healthcare needs, the significant factors associated with unmet medical need were gender, marital status, residence in a metropolitan area, low household income, economic activity participation, self-employed insured, physically disabled, low subjective health status, and health-risk factors such as current smoking and drinking. Conclusion: The results of this study suggest that having PHI may reduce experience of unmet healthcare needs. Findings unmet healthcare needs factors according to various subjects may be useful in consideration of setting policies for improving accessibility to healthcare in Korea.

• Safety and Health at Work
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• v.10 no.3
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• pp.265-274
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• 2019

Background: Methyl alcohol poisoning in mobile phone-manufacturing factories during 2015-2016 was caused by methyl alcohol use for cleaning in computerized numerical control (CNC) processes. To determine whether there were health complications in other workers involved in similar processes, the Occupational Safety and Health Research Institute conducted a survey. Methods: We established a national active surveillance system by collaborating with the Ministry of Employment and Labor and National Health Insurance Service. Employment and national health insurance data were used. Overall, 12,048 employees of major domestic mobile phone companies and CNC process dispatch workers were surveyed from 2016 to 2017. We investigated methyl alcohol poisoning by using the national health insurance data. Questionnaires were used to investigate diseases due to methyl alcohol poisoning. Results: Overall, 24.9% of dispatched workers were employed in at least five companies, and 23.9% of dispatched workers had missing employment insurance history data. The prevalence of blindness including visual impairment, optic neuritis, visual disturbances, and alcohol toxicity in the study participants was higher than that reported in the national health insurance database (0.02%, 0.07%, 0.23%, and 0.03% versus 0.01%, 0.07%, 0.13%, and 0.01%, respectively, in 2015). Moreover, 430 suspicious workers were identified; 415 of these provided an address and phone number, of whom 48 responded (response rate, 11.6%). Among the 48 workers, 10 had diseases at the time of the survey, of whom 3 workers were believed to have diseases related to methyl alcohol exposure. Conclusion: This study revealed that active surveillance data can be used to assess health problems related to methyl alcohol poisoning in CNC processes and dispatch workers.

• Archives of Craniofacial Surgery
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• v.22 no.6
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• pp.319-323
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• 2021

Background: Prophylactic antibiotics are used to prevent surgical wound infection; however, proper indications must be followed with careful consideration of the risks and benefits, especially in clean or clean-contaminated wounds. Nasal bone fractures are the most common type of facial bone fracture. The most common method for treating nasal bone fracture is closed reduction, which is performed inside the nasal cavity without an incision. The purpose of this study was to determine the need for antibiotic use in the closed reduction of nasal bone fractures. Methods: A retrospective study was conducted using data from the National Insurance Service Ilsan Hospital of the Republic of Korea between 2016 and 2018. The records of patients who underwent closed reduction of nasal bone fracture were reviewed and classified according to sex, age, comorbidities, perioperative antibiotic usage, postoperative complications, nasal packing, anesthesia type, surgeon's specialty, and operation time. Results: Among the 373 patients studied, the antibiotic prescription rate was 67.3%. Just 0.8% of patients were prescribed preoperative antibiotics only, 44.0% were prescribed postoperative antibiotics only, and 22.5% were prescribed both preoperative and postoperative antibiotics. There were no cases that satisfied the definition of "surgical site infection." Furthermore, 2.1% of infection-related complications (e.g., mucosal swelling, synechia, and anosmia) occurred only in the antibiotic usage group. The use of nasal packing, anesthesia type, and surgeon's specialty did not show any difference in infection-related complication rates. Conclusion: According to the study findings, the routine use of perioperative antibiotics is not recommended in uncomplicated nasal bone fracture surgery.

• PNF and Movement
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• v.22 no.1
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• pp.101-111
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• 2024

Purpose: The purpose of this study was to investigate physical activity as a risk factor for neck pain recurrence using the National Health Insurance Data Sharing Service that utilizes a nationwide cohort in South Korea. Methods: Medical records spanning a two-year period were extracted from the National Health Insurance database for 541,937 patients who sought healthcare services for neck pain (ICD 10 codes: M54.2) in 2020 and completed the national health examination survey. Selected variables for analysis included age, gender, health insurance premium decile, regional health vulnerability index, body mass index (BMI), acuity, blood pressure, and types of physical activity. A mixed-effect multivariate logistic regression analysis was conducted to examine the recurrence rate of neck pain and identify risk factors for neck pain recurrence. Results: Among the participants, 124,433 patients (23.0%) experienced a recurrence of neck pain within two years, with higher recurrence rates observed among older individuals and females. Regression analysis revealed that the risk of neck pain recurrence increased with age (OR=1.51), being female (OR= 1.10), being a medical aid recipient (OR=1.51), and having anaerobic (OR=1.04) or vigorous physical activities (OR=1.06). By contrast, an increased health insurance premium decile (OR=0.96) and having moderate physical activity (OR=0.97) were associated with a decreased risk of neck pain recurrence. Conclusion: This study highlights the importance of moderate physical activity as an effective strategy for reducing the recurrence of nonspecific neck pain, underscoring the necessity for personalized physical activity programs for patients.

• Journal of the Korean Society of Radiology
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• v.81 no.5
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• pp.1024-1037
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• 2020

The resource-based relative value scale (RBRVS) compares the value of a medical practice to the consumption of resources, which consist of the work of the physician, practice expenses, and professional liability insurance. At the time of the 2nd revision of RBRVS, the fee for radiological examinations had been reduced due to the high preservation rate. In RBRVS, practice expenses account for most of the compensation of radiological examinations, and physicians' work is relatively undervalued. A new healthcare policy (Moon Jae-In care) consists of the expansion of the National Health Insurance (NHI) coverage, reduction of patient charges for the vulnerable class, and support for catastrophic medical expenses. However, Moon Jae-In care is expected to negatively affect the NHI in Korea financially. The expansion of the insurance coverage for ultrasonography and MRI examinations is a significant part of the Moon Jae-In care, and radiological societies should establish fair compensations for physicians' work within the field of radiology while implementing the Moon Jae-In care.

• Journal of Society of Preventive Korean Medicine
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• v.28 no.1
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• pp.69-87
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• 2024

Objectives : This study is to investigate the current National Health Insurance Database cohort studies related to complications of Parkinson's Disease (PD) and suggest the design of Korean medical epidemiological studies of PD. Methods : Nationwide longitudinal studies of PD patients in South Korea were collected through Pubmed and the Korea Citation Index (KCI). We selected cohort studies that used the National Health Insurance Database in Korea and targeted Parkinson's disease patients. Studies published before February 2024 were categorized according to study designs. We examined variables and covariates, enroll dates and matching methods. Results : Of a total of 536 studies, 18 studies met the inclusion criteria. All studies used the National Health Insurance (NHI) Research Database and among them, 5 used sample data and one senior database. Studies can be classified into two types. 11 cohort studies were comparing PD patients and non-PD patients. Another type was 4 PD patients cohort studies. Most studies used two diagnostic codes (G20 and V124) for inclusion criteria. Enroll periods were from 2002 to 2017, and follow-up periods were from 7 to 14 years. 16 studies considered age and sex as covariates. 15 studies used the propensity score matching method to increase the level of causality. There was only one study related to the Korean medical treatment. Conclusion : In future cohort studies on Korean medical treatment, more attempts should be made to reveal the effect of the treatments on PD patients by defining inclusion criteria for patient groups, covariates, exposure variables, and assessment indicators more operatively.

• The Korean Journal of Applied Statistics
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• v.28 no.4
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• pp.663-683
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• 2015

The change of the population pyramid due to low fertility and rapid aging threatens the financial sustainability of National Health Insurance. We construct statistical models for prevalence rates and medical expenses using National Health Insurance Service (NHIS) sample cohort data from 2002-2013. We then project yearly expenditures and income of national health insurance until 2060 that considers various assumptions in regards to future population structure and economic conditions. We adopt a VECM-LC model for prevalence rates and the double exponentially smoothing method for the per capita co-payment of healthcare expense (in which the two models are institution-disease-sex-age specific) to project of national health insurance expenditures. We accommodate various assumptions of economic situations provided by the national assembly and government to produce a financial projection for national health insurance. Two assumptions of dependents ratios are used for the projection of national health insurance income to conduct two future population structures by the two assumptions of aging progresses and various assumptions on economic circumstances as in the expenditure projection. The health care deficit is projected to be 20-30 trillion won by 2030 and 40-70 trillion won by 2060 in 2015 constant price.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.3
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• pp.108-117
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• 2020

The purpose of this study is to analyze the blind spots of Korea's employment insurance system from a gender perspective. The data used for this study was derived from 12th (2009) and 20th (2017) years of the Korean Labor and Income Panel Studies. Logistic regression analysis was performed to analyze the causes of the blind spot. As a result, the gender gap decreased by 5% in 2017 compared to that in 2009. In the coverage of employment insurance by gender, women are more likely to join when controlling for other demographic factors. If the conditions in the labor market are the same, then women's insurance coverage is likely to be higher than that of men. The policy suggestions are as follows. The current employment insurance system has a greater impact on the labor market characteristics than the difference in the participation rate according to gender itself. The results of this study show that bridging the gender gap in the labor market is an important way of bridging the gender gap in employment insurance coverage. In the short term, the social insurance subsidy program may be effective, but policy efforts are fundamentally needed to improve the employment environment of women and low-wage workers.

• Health Policy and Management
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• v.29 no.2
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• pp.206-219
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• 2019

This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2018 constructed according to the SHA2011, which is a manual for System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analyzing health accounts of OECD member countries. Particularly, scale and trends of the total CHE financing as well as public-private mix are parsed in depth. In the case of private financing, estimation of total expenditures for (revenues by) provider groups (HP) is made from both survey on the benefit coverage rate of National Health Insurance (by National Health Insurance Service) and Economic Census and Service Industry Census (by National Statistical Office); and other pieces of information from Korean Health Panel Study, etc. are supplementarily used to allocate those totals into functional classifications. CHE was 144.4 trillion won in 2018, which accounts for 8.1% of Korea's gross domestic product (GDP). It was a big increase of 12.8 trillion won, or 9.7%, from the previous year. GDP share of Korean CHE has already been close to the average of OECD member countries. Government and compulsory schemes' share (or public share), 59.8% of the CHE in 2018, is much lower than the OECD average of 73.6%. 'Transfers from government domestic revenue' share of total revenue of health financing was 16.9% in Korea, lower than the other social insurance countries. When it comes to 'compulsory contributory health financing schemes,' 'transfers from government domestic revenue' share of 13.5% was again much lower compared to Japan (43.0%) and Belgium (30.1%) with social insurance scheme.