• 대한예방의학회:학술대회논문집
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• 대한예방의학회 2005년도 제57차 추계 학술대회 연제집
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• pp.357-357
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• 2005

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 2005년도 제57차 추계 학술대회 연제집
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• pp.322-322
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• 2005

• Journal of Preventive Medicine and Public Health
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• 제33권1호
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• pp.76-82
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• 2000

Objectives : We attempted to assess He accuracy of ICD codes for cerebrovascular diseases in medical insurance claims (ICMIC) and to investigate the reasons for error. This study was designed as a preliminary study to establish a nationwide surveillance system. Methods : A total of 626 patients with medical insurance claims who indicated a diagnosis of cerebrovascular diseases during the period from 1993 to 1997 was selected from the Korea Medical Insurance Corporation cohort (KMIC cohort: 115,600 persons). The KMIC cohort was 10% of those insured who had taken health examinations in 1990 and 1992 consecutively. The registered medical record administrators were trained in the survey technique and gathered data from March to May 1999. The definition of cerebrovascular diseases in this study included cases which met ore of two criteria (Minnesota, WHO) or 'definite stroke' in CT/MRI finding. We questioned the medical record administrators to explain the error if the final diagnoses were not coded as stroke. Results : The accuracy rate of the ICMIC was 83.0% (425 cases) Medical records were not available for 8.2% (51 cases) due to the closing of hospitals, the absence of a computer system or omission of medical record, etc. Sixty-three cases (10.0%) were classified as impossible to interpret due to insufficient records in 'major clinical symptoms' or 'neurological deficits'. The most common reason was 'to meet review criteria of medical insurance benefits (52.9%)'. The department where errors in the ICMIC occurred most frequently was the department for medical insurance claims in the hospital. Conclusion : The accuracy rate of the ICMIC was 83.0%.

• Journal of Preventive Medicine and Public Health
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• 제29권4호
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• pp.843-851
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• 1996

To estimate the incidence of uterine cervix cancer among Korean women, we have conducted a study using the claim data on the beneficiaries of Korea Medical Insurance Corporation (KMIC). All medical records of the potential cases with diagnosis of ICD-9 180, 181, 182, 199, 219, 233 in the claims sent by medical care institutions in the whole country to the KMIC from January 1988 to December 1989, were abstracted and Gynecology specialist reviewed the records to identify the new cases of uterine cervix cancer among the potential cases during the corresponding period. Using these data, the incidence of uterine cervix cancer among Korean women was estimated as of July 1, 1988 to June 30, 1989. The crude rate was estimated to be 17.34(95% CI: $16.76\sim17.92$) per 100,000 and the cumulative rates for the ages $0\sim64\;and\;0\sim74$ were 1.7% and 2.2%, respectively. The age-adjusted rate for the world population was 19.93 per 100,000 which was higher than those of other Asian countries including China and Japan in $1983\sim1987$. The truncated rate for ages $35\sim64$ was 52.05 per 100,000 which was one of the highest in the world. With increasing age, the incidence rate increased to 78.11 per 100,000 in women aged $55\sim59$ years, then it decreased in the older groups. This finding suggests that detecting rate of uterine cervix cancer may decrease in women aged 60 years or older due to inadequate medical care seeking behavior. In the geographical area, the SIR of Jeju province was significantly low but it might be due to statistical unstability by small case numbers.

• Journal of Preventive Medicine and Public Health
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• 제25권2호
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• pp.115-126
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• 1992

우리나라 일부지역의 암사망률을 추정하기 위하여 경상남도지역을 대상으로 조사연구를 시행하였다. 조사대상연구는 공무원및교직원의료보험공단 경상남도지부 피보험자 및 피부양자들이며, 이들중 1989년 1월부터 1990년 12월까지의 사망자 3,867명에 대하여 사망원인을 조사하였다. 사망원인의 확정은 사망진단서 및 의료보험공단의 전산화된 의료기관 이용자료를 기본자료로 3단계에 걸쳐 시행하였다. 사망진단서를 이용한 1차조사, 의료기관 이용자료를 이용한 2차조사, 가족설문조사인 3차조사를 시행한 결과 암질환으로 인한 사망자는 990명이었다. 사망원인이 암질환인 사망자 990례를 분석하여 우리나라 경상남도지역의 암사망률 및 부위별 암사망률을 추정하였다. 우리나라 경상남도지역 암질환의 조사망률은 10만 인 년당 남자 138.7, 여자 65.7으로 추정되었다. 또한 부위별 암사망률의 순위는 남자의 경우 위암, 간암, 폐암, 식도암, 조혈기계 암의 순이었으며, 여자는 위암, 폐암, 간암, 유방암, 자궁경부암의 순으로 나타났다.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 2002년도 제54차 추계 학술대회 연제집
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• pp.352-353
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• 2002

• Journal of Preventive Medicine and Public Health
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• 제29권3호
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• pp.555-563
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• 1996

Nationwide incidence survey was conducted to estimate the annual incidence rates of colorectal cancer among Koreans between Jan 1, 1988 and Dec 31, 1989. The population of the incidence survey was the beneficiaries of Korea Medical Insurance Corporation (KMIC), which were about 4,500,000 persons. The medical records of patients with diagnosis of either ICD-9 153(colon cancer), 154(rectal caner), 197(secondary malignant neoplasm of digestive and respiratory system), or 211(benign neoplasm of digestive system) were abstracted for the period with the standard format. The diagnosis was confirmed by one oncologist through the review of these abstracts. The numerator of the rate was finally defined as the incident colorectal cancer cases diagnosed between July 1, 1988 and June 30, 1989. The crude annual incidence of colorectal cancer for men was 13.1 per 100,000 and 10.6 for women, which was still low when compared with those of Japan and China during the same period. Age-adjusted sex ratio was 1.2 for right-sided colon cancer and 1.9 for left-sided colon cancer. The excess of right colon cancer among postmenopausal women was remarkable, so further analytical approach would be needed to investigate which factors are related with this phenomenon.

• 보건행정학회지
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• 제5권2호
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• pp.155-172
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• 1995

This study is an empirical analysis on the equity in the delivery of heatlh care under the Korean Medical Insurance Corporation System. The purposes of this study are to find out effects of income on the health care utiliztion and measure the income-related inequity in the distribution of health care. This study was carried out based on the fact that the health insurance program has been organized to achieve the equity objective, "equal treatment for equal needs". Of 41, 828 insured persons who had been diagnosed in the 1993 Health Screening Test and utilifzation data from 1, January 1993 through 31, December 1993 were derived from the Benefit Managment File. Inequity was measured by means of I) share approach, ii) standardization concentration curve approach, iii) inequity index, iv) test for inequity. The major findings were as follows : 1. The expenditure shares of the top two quintile groups exceeded their morbidity shares, whereas the opposite was true of the bottom three quintile groups, Which showed a positive HI$_{LG}$ inequity index, suggesting the presence of some inequity favoring the rich group. 2. Compared with other residential areas, the rural area showed the highest positive HI$_{LG}$ irrespective of need indicatior applied. 3. Standardized expenditure concentration indices adjusted by age, gender and need structure were also found to be positive, and therefore still indicated that there has been inequity favoring the rich after the standardization. 4. The Loglikelihood Ratio (LR) test for the statistical significance of income-related inequity of medical care utilization was carried out using the logistic regression model. The resulting loglikelihood ratio test statistic value was 176, which did exceed the 0.5 percent critical value of the chi-square distribution with 28 degrees of freedom, which is 50.993. Therefore, the null hypothesis of no income-related inequity of medical care utilization was rejected at the 99.5 percent confidence level. 5. The Regression based F-test has been carried out for analyzing the income-related inequity of medical expenditure in terms of age, gender, morbidity indicators as explanary variables. The hypothesis of the absence of income-relate inequity was rejected for all need indicators at the 95% confidence level.nce level.

• Journal of Preventive Medicine and Public Health
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• 제28권1호
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• pp.207-223
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• 1995

A new medical delivery system which regulated outpatient department(OPD) use from tertiary care hospitals was adopted in 1989. Under the new system, patients using tertiary care hospital OPD without referral slip from clinics or hospitals could not get any insurance benefit for the services received from the tertiary care hospital. This study was conducted to evaluate the Patient Referral System(PRS) with respect to health care expenditures and utilization. Two data sets were used in this study. One was monthly data set(from January 1986 to December 1992) from the Annual Report of Korea Medical Insurance Corporation(KMIC). The other was monthly joint data set composed of personal data of which 10% were selected randomly with their utilization data of KMIC from January 1988 to December 1992. The data were analyzed by time-series intervention model of SAS-ETS. The results of this study were as follows: 1. There was no statistically significant changes in per capita expenditures following PRS. 2. Utilization episodes per capita was increased statistically significantly after implementation of PRS. The use of clinics and hospitals increased significantly, whereas in tertiary care hospitals the use decreased significantly immediately after implementation of PRS and increased afterwards. 3. Follow-up visits per episode were decreased statistically significantly after implementation of PRS. The decrease of follow-up visits per episode were remarkable in clinics and hospitals, whereas in tertiary care hospitals it was increased significantly after implementation of PRS. 4. There was no statistically significant changes in prescribing days per episode following PRS. Futhermore, clinics and hospitals showed a statistically significant decrease in prescribing days per episode, whereas in tertiary care hospital it showed statistically significant increase after implementation of PRS. 5. Except high income class, the use of tertiary care hospitals showed statistically significant decrease after implementation of PRS. The degree of decrease in the use of tertiary care hospitals was inversely proportional to income. These results suggest that the PRS policy was not efficient because per capita expenditures did not decrease, and was not effective because utilization episodes per capita, follow-up visits per episode. and prescribing days per episode were not predictable and failed to show proper utilization. It was somewhat positive that utilization episodes per capita were decreased temporarily in tertiary care hospitals. And PRS policy was not appropriate because utilization episodes per capita was different among income groups. In conclusion, the PRS should be revised for initial goal attainment of cost containment and proper health care utilization.

• Journal of Preventive Medicine and Public Health
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• 제35권1호
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• pp.41-48
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• 2002

Objectives : To review the drug prescription pattern of antiulcerative agents for elderly inpatients, Methods : The study population comprised inpatients of community hospitals who were members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, beneficiaries of the Korea Medical Insurance Corporation (KMIC) and residing in Busan city in 1993. The drug prescription information was collected from the claims data of hospitals where the cohort members received medical care between January 1993 and December 1594. The information included personal identification, age, gender, diagnosis, drug dosage, date of hospital admission and name of medical institutions where the study subjects received drug prescriptions. The data analysis produced outcomes in terms of distribution of antiulcerative agents by class and by medical institution and trend of relative prescription, Analysis was also performed in terms of combined prescriptions of antiulceratives and drugs that could induce risk from drug interaction with antiulceratives. Results : The number of patients prescribed antiulcerative agents was 1,059 (64,9%) male and 1,724 (65.5%) female among the total inpatients. An antacid and composite agent was the most frequently prescribed antiulcerative agent (70.8%), followed by $H_2$ antagonist (16.0%), Among the potential drugs that could induce risk from drug interaction with the antiulcerative agents, diazepam was the most frequently prescribed. The proportion of diazepam co-prescription was 22.5% of the total cimetidine prescriptions and 14.5% of the fetal omeprazole prescriptions. Conclusions : Antiulcerative drugs were frequently prescribed in the elderly inpatients. The adverse drug reaction could possibly be due to drug interaction. The study results could be used as fundamental data for further drug utilization review of antiulceratiye agents.