• Research in Community and Public Health Nursing
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• v.26 no.1
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• pp.11-17
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• 2015

Purpose: This study was to ascertain whether there are differences in health care utilization and expenditure for Type I Medical Aid Beneficiaries before and after applying Copayment. Methods: This study was one-group pretest posttest design study using secondary data analysis. Data for pretest group were collected from claims data of the Korea National Health Insurance Corporation and data for posttest group were collected through door to-door interviews using a structured questionnaire. A total of 1,364 subjects were sampled systematically from medical aid beneficiaries who had applied for copayment during the period from December 12, 2007 to September 25, 2008. Results: There was no negative effect of copayment on accessibility to medical services, medication adherence (p=.94), and quality of life (p=.25). Some of the subjects' health behaviors even increased preferably after applying for copayment including flu prevention (p<.001), health care examination (p=.035), and cancer screening (p=.002). However, significant suppressive effects of copayment were found on outpatient hospital visiting days (p<.001) and outpatient medical expenditure (p<.001). Conclusion: Copayment does not seem to be a great influencing factor on beneficiaries' accessibility to medical services and their health behavior even though it has suppressive effects on outpatients' use of health care.

• Journal of Preventive Medicine and Public Health
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• v.33 no.4
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• pp.495-504
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• 2000

Objectives : To examine various dimensions of consumer ratings of health care service with factor analysis and to find which factors influence the overall quality of health care service. Methods : A cross-sectional study was conducted on outpatients of a general hospital located in Sungnam City. A self-administered questionnaire was used to assess the consumer's ratings of health care service received. The response rate was 92.8% with a total of 537 persons completing the questionnaire. Factor analysis was performed on 34 items evaluating the quality of health care service. Items were grouped into 5 dimensions as a result of factor analysis and the reliability and validity of influence on patient service assessment were evaluated for each dimension. Results : The 5 dimensions were as follows, 1) physician services, 2) non-physician services, 3) process 4) facilities, and 5) cleanliness A positive correlation with the quality of health care service was found for the dimensions of non-physician services and process, while no significant correlation was found for the dimensions of physician services, facilities, and cleanliness. Conclusions : The result of this study may provide basic information for the development of future self-administered questionnaires of consumer ratings and for the evaluation of quality improvement activities in hospital outpatient settings.

• Korea Journal of Hospital Management
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• v.19 no.4
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• pp.57-68
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• 2014

Since the introduction of National Health Insurance(NHI) in 1977, it has grown rapidly and contributed to extend patient's access to the health care services. However, limited coverage for health care services of NHI has been ongoing challenge and private health insurance(PHI) has been rising as an alternative source of enhancing coverage and saving out-of-pocket(OOP) expenditure for patients. In this study, after controlling for socio-demographic, economic, health related variables, we identified the patients' healthcare utilization and subsequent OOP expenditure depending on their PHI enrollment and their enrollment types(fixed benefit, indemnity, fixed benefit plus indemnity). Data were collected from the 2010 Korean Health Panel. The unit of analysis was a member of household(n=13,324). Of the 13,324 cases, 70.7% of patients held PHI, in detail, fixed benefit(47.0%), indemnity(3.6%), fixed benefit plus indemnity(20.1%). Major findings showd that patients who enrolled in PHI used more outpatient services(outpatient visit, number of physician visit, number of examination) and spent more OOP expenditure than non-PHI patients. There were also differences of healthcare utilization and OOP expenditure among the types of PHI. In addition, PHI patients used more inpatient services(inpatient use, number of hospitalization, LOS), but there was no significant difference between PHI and non-PHI patients with regard to the OOP expenditure. Thus, we could not find any distinct relationship between the types of PHI and patients' tertiary hospital use. Policy-makers should need careful political deliberation for monitoring the effect of PHI on health care utilization and subsequent expenditure not only to improve patients' coverage but also to save their OOP expenditures.

• Korea Journal of Hospital Management
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• v.26 no.2
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• pp.1-16
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• 2021

This study aims to examine the effect of integrated health and welfare(IHW) services on medical use and medical expenses in Korean Veteran Hospitals. Data on the volume of medical use and medical expenses were collected from two patient groups of 5 Veterans' Hospitals: the beneficiary group who has received IHW services and the non-beneficiary group who has not. Each group was composed of 265 patients respectively. The results of the study revealed that the volume of home nursing services, home rehabilitation services, ambulatory services have increased significantly, whereas the average length of stay, number of using emergency services, and average medical expenses have decreased after receiving integrated health services in the beneficiary group. In contrast, the non-beneficiary group showed much more increase both in the volume of inpatient and outpatient services, as well as the average medical expenses, compared to those of the beneficiary group. This results imply that the provision of IHW services have positive impacts on the enhancing the effectiveness of the medical resources utilization for the veteran patients.

• YAKHAK HOEJI
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• v.58 no.3
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• pp.200-207
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• 2014

This study aimed to assess the quality of outpatient antibiotic consumption in Korea compared with other countries. We used the National Health Insurance claims data for outpatient services in March, June, September, and December in 2012 and calculated nine indicator values based on the 12 European Surveillance of Antimicrobial Consumption (ESAC) drug-specific quality indicators. Indicator values in this study reflect the yearly use of antibiotic expressed in defined daily doses for 1,000 inhabitants per day (DID) and the use of main subclasses of antibiotics expressed in DID and as percentage of the total antibiotic use. Korea showed lower quality in the consumption of total antibiotics (J01), especially in the use of Cephalosporins (J01D) expressed in DID. Korea also showed low quality with regard to the use of narrow/broad spectrum antibiotics. The percentage of the use of narrow-spectrum Penicillins (J01CE) was lowest in Korea. The quality on the use of the third- and fourth-generation cephalosporin (J01(DD+DE)) was the fourth lowest among 26 countries. High rates of antibiotic resistance and payment system based on fee-for-service might have influenced on the high consumption of the broad spectrum antibiotics in Korea. It needs to further investigate the use of broad-spectrum antibiotics to identify the target of strategies promoting quality use of antibiotics in Korea.

• Health Policy and Management
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• v.32 no.2
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• pp.154-163
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• 2022

Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• Health Policy and Management
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• v.17 no.2
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• pp.33-51
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• 2007

The disabled population is a vulnerable group, having very complex medical conditions, but little is known about differences in the level of access by type of disability. This study was performed to investigate the differences of health care utilization by the type of disability. The database was constructed from registry of the disabled and health insurance and medical aid claims data submitted to the Korea Health Insurance Cooperation during in the year 2003. The disability classified three groups according to the Disabled Welfare Act; physically disability with external dysfunction, physically disability with organic disease, and mentally disability. There were huge differences in health care utilization by the type of disability. For the inpatient care, those with a mental disability were more likely to utilize health care services in terms of average visit number of medical facilities and visit days per case, but the treatment amount per case was the highest in physically disabled with organic disease. For the outpatient care, those who the physically disabled with organic disease were more likely to utilize health care services in terms of average visit number of medical facilities, treatment amount per case, and the treatment days per case. Also, those who physically disabled with organic disease were more likely to utilize general hospital for both inpatient and outpatient care, and spent more out-of-pocket expenditure. As the number of persons with disabilities rises, the need to consider new approaches to protecting their health grows increasingly. Especially, Korean health care system should be refined to be more responsive to the needs of the type of disability.

• Korea Journal of Hospital Management
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• v.22 no.1
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• pp.1-9
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• 2017

Purpose : Many studies showed that having a usual source of care improved the efficient access of healthcare service. However in Korea there have been few studies on the usual source of care. So this study aims to find whether having a usual source of care affect the medical utilization and expense. Methodology/Approach : We used the Korean Health Panel data in 2012, 2013 to examine the change of utilization and expenses in ambulatory care affected by having a usual source of care. We selected 1,215 hypertension patients without usual source of care in 2012 and performed linear regression analysis to identify the difference between treatment group(with usual source of care in 2013) and control group(without usual source of care in 2013). Then we performed analysis again separated by the age group. Findings : Among study population, 711(58.5%) reported that they have a usual source of care in 2013. Treatment group reported 1.85 less increase in outpatient visits and 69,234 won less increase in expense than control group with weak significance(visit ${\beta}$ -1.85 p-value 0.0807, expense ${\beta}$ -69,234 p-value 0.0541). People under the age of 65 showed significant change in outpatient visits for tertiary hospital (visit ${\beta}$ -0.78 p-value 0.0154, expense ${\beta}$ -91,462 p-value 0.0168). The analysis which focused outpatient for mild disease showed similar trend. Practical Implications : This study supports the positive effect of having usual source of care which decrease inefficient outpatient utilization. Promoting physician-patient relationships is important for efficiency of healthcare service.

• Research in Community and Public Health Nursing
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• v.27 no.3
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• pp.272-283
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• 2016

Purpose: This is a comparative study using secondary data from the Korean national long term care (LTC) insurance. Methods: Visiting nursing (VN) service users (n=666) and non-users (n=4,375) were extracted and compared in terms of medical expenditures, length of hospitalization, and annual number of ambulatory care visits to investigate effects of VN services in LTC. Results: Total health care expenditures were compared between the two groups and it was found that VN service users spent about $ 1700 than non-users for their medical costs between 2009 and 2011. The average length of in-hospital stay for VN service users was 19.4 days shorter than that of non-users. However, using VN services did not significantly influence the annual number of ambulatory care visits. Conclusion: The study has found that VN services are effective ways of providing community-based LTC services. We recommend LTC policy makers to further utilize VN services to deliver cost effective health care services.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.7
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• pp.443-452
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• 2018

The purpose of this study was to investigate the utilization behavior of medical services according to the characteristics of socioeconomic status (SES) and prevalence by using the 6th National Health and Nutrition Survey data for adults over 25 years old. Frequency and technical statistical analysis, ANOVA, ${\chi}^2$-test, and regression analysis were performed using SPSS 23.0. The results were as follows: more female than male, 65 years old and over, high school graduate, and unemployed and income quintiles were similar. The SES score considering education level, function, and income quintiles was the highest at 7-8, and most of the respondents felt moderate about their subjective health condition. The mean number of prevalence was $1.07{\pm}1.497$, the mean utilization of outpatient services was $0.50{\pm}0.045$, and the mean number of inpatient services use was $0.12{\pm}0.454$. Depending on general characteristics, there was a significant difference between subjects with prevalence and subjective health conditions. Higher age was associated with lower education, skill level, income, and SES score, and average prevalence was associated with poor subjective health conditions. More serious prevalence was associated with greater utilization of inpatient services. More chronic prevalence was associated with utilization of outpatient services. In other words, higher SES score was associated with lower overall use of medical services. Lower SES score was associated with higher use of medical services. In conclusion, we must develop appropriate health education programs that can prevent diseases in groups with low socioeconomic characteristics. There is the need to construct and implement a community-based appropriate health service system so that proper medical services can be used.