• Journal of Oral Medicine and Pain
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• v.34 no.1
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• pp.63-79
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• 2009

While previous epidemiological studies on temporomandibular disorders (TMD) have been based on a given health center or population sample, no study has been performed on general population of Korea, especially concerning about treatment pattern such as clinician’s specialty involved in TMD treatment, types and amount of prescription medication and cost. This study aimed to investigate magnitude of health visits and treatment patterns for Korean patients with TMD through the computerized database of Health Insurance Review and Assessment Service (HIRAS). Inclusion criteria were all patients registered on the HIRAS database over 3 years' period from 2003 to 2005 and the medical records of patients with TMD as a main diagnosis were extracted. Information collected was as follows; distribution related to gender, age and region and type of hospital the patients visited, treatment duration, clinicians' specialty involved in treatment, cost, types of prescription medication and surgical treatment. The results of this study indicated that 0.15% of the population yearly sought TMD treatment, presenting with increase of incidence over the three years. Most of TMD patients were women (99.8%) and the biggest age group was second and third decades and decreased with age. Seoul and Kyeonggi province presented with higher incidence of TMD compared to the other regions of Korea, which seems to be related with magnitude of population. 56% of TMD patients visited primary care sector and the numbers of treatment visits was the highest in dental clinic (38.4%), followed by orthopedics (28%) and ENT (13.6%) clinics in order. Duration of prescription medication was the longest for anti-inflammatory analgesics, followed by antipsychotic drugs and muscle relaxants. Inpatient care related to TMD was primarily performed in dental hospital compared to medical hospital. Medical database of HIRAS provided comprehensive and vast information on epidemiologic characteristics and treatment patterns for patients seeking TMD treatment, which can be more reliable data to expect medical demand for TMD in condition that accurate diagnosis and standardized treatment is delivered in clinical settings.

• Journal of Korean Medicine Rehabilitation
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• v.31 no.4
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• pp.105-116
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• 2021

Objectives Lumbar herniated intervertebral disc (L-HIVD) is common disease in which Western-Korean collaborative treatment is performed in Korea. This study aimed to analyze Western-Korean collaborative treatment utilization of Korean patients with L-HIVD using Health Insurance Review & Assessment Service's Patients Sample Data. Methods This study used the Health Insurance Review & Assessment Service-National Patient Sample (HIRA-NPS) in 2018. Claim data of L-HIVD patients were extracted. The claim data were rebuilt with the operational concept of 'episode of care' and divided into Korean medicine episode group (KM), Western medicine episode group (WM) and collaborative treatment episode group (CT). General characteristics, medical expenses and healthcare utilization were analyzed. In addition, the difference of average visit day and average medical expenses between non-collaborative group (KM plus WM) and CT were analyzed by the propensity score matching method. Results A Total of 64,333 patients and 365,745 claims were extracted. The number of episodes of WM, KM and CT was 69,383 (92.97%), 3,903 (5.23%), and 1,341 (1.80%) respectively. The frequency of collaborative treatment episode was higher in women and the age of 50s. The most frequently described treatment in CT was acupuncture therapy. As a result of the propensity score matching, the number of visit days and medical expenses in the collaborative treatment group was higher than in the non-collaborative group. Conclusions The analysis of healthcare utilization of Korean-Western collaborative treatment may be used as basic data for establishing medical policies and systematic collaborative treatment model in the future.

• 한국노년학
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• v.38 no.3
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• pp.725-744
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• 2018

The purpose of this study is to review selected research articles on Social Welfare in Journal of the Korean Gerontological Society from 2008 to 2017 during 10 years periods, and suggest directions and implications for future research in the field of Gerontological Social Welfare. A total of 273 research articles were selected out of all published 655 articles in Journal of the Korean Gerontological Society in last 10 years. And relevant review articles were selected on the basis of cross checking among authors who majored in social welfare. Selected articles were analyzed for ecological system perspective, research subjects, and research methods. The major findings of this study were as follows. First, ecological system were classified into three categories: 1) macro system(52 articles); 2) mezzo system(120 articles); 3) micro system(101 articles). Second, the research subjects were classified into five categories: 1) social problem of the elderly(151 articles); 2) laws and policies(38 articles); 3) social welfare service for the elderly(28 articles); 4) day service and residential service(39 articles), 5) social participation for the elderly(31 articles). Third, the research methods were classified into 5 categories: 1) qualitative research(213 articles); 2) qualitative research(39 articles); 3) literature review(14 articles); 4) meta research(4 articles); 5) mixed research(3 articles). Finally, there are some important research directions and implications in the field of social welfare for the elderly. First, there should be more balance researches related to the ecological system perspectives in the field of social welfare for the elderly. Second, there should be more systematic researches to analyze critical problems and social issues related to the aging and senior citizens, and developing better interventions and social welfare policies for the elderly. Third, there should be more researches related to evidence based approaches, and utilizing various research methods to examine social problems and major issues for the elderly persons.

• Health Policy and Management
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• v.27 no.2
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• pp.167-176
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• 2017

Background: This study aimed to analyze the impact of community health care resources on the place of death of older adults with dementia compared to those with cancer in South Korea, using public administrative big data. Methods: Based on a literature review, we selected person- and community-level variables that can affect older people's decisions about where to die. Data on place-of-death and person-level attributes were obtained from the 2013 death certification micro data from Statistics Korea. Data on the population and economic and health care resources in the community where the older deceased resided were obtained from various open public administrative big data including databases on the local tax and resident population statistics, health care resources and infrastructure statistics, and long-term care (LTC) insurance statistics. Community-level data were linked to the death certificate micro data through the town (si-gun-gu) code of the residence of the deceased. Multi-level logistic regression models were used to simultaneously estimate the impacts of community as well as individual-level factors on the place of death. Results: In both the dementia (76.1%) and cancer (87.1%) decedent groups, most older people died in the hospital. Among the older deceased with dementia, hospital death was less likely to occur when the older person resided in a community with a higher supply of LTC facility beds, but hospital death was more likely to occur in communities with a higher supply of LTC hospital beds. Similarly, among the cancer group, the likelihood of a hospital death was significantly lower in communities with a higher supply of LTC facility beds, but was higher in communities with a higher supply of acute care hospital beds. As for individual-level factors, being female and having no spouse were associated with the likelihood of hospital death among older people with dementia. Conclusion: More than three in four older people with dementia die in the hospital, while home is reported to be the place of death preferred by Koreans. To decrease this gap, an increase in the supply of end-of-life (EOL) care at home and in community-based service settings is necessary. EOL care should also be incorporated as an essential part of LTC. Changes in the perception of EOL care by older people and their families are also critical in their decisions about the place of death, and should be supported by public education and other related non-medical, social approaches.

• Health Policy and Management
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• v.25 no.1
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• pp.40-52
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• 2015

Background: The purpose of this study was to analyze the increase in Grade of Nursing Management Fee of medical institutions and establish a reasonable government policy by examining which factors affect the increase of nurse staffing. Methods: Analyzing data collected from the Health Insurance Review & Assessment Service resource management department with targets of 1,104 medical institutions. The study period was 5 years from June 30, 2008 to June 30, 2013. SAS ver. 9.2 (SAS Institute Inc., Cary, NC, USA) was used for statistical analysis. The data was analyzed by a chi-square test and also conducted muiltivariate logistic regression analyses for variables of basic characteristics, human resource characteristics, and material resources. Results: Adjusted odds ratio (AOR) of the rise in Grade of Nursing Management Fee among other hospitals compared to hospitals owned by government or universities was 0.264. The AOR in hospitals established after November 2006 compared to those before June 1995 was 2.383. The AOR in Gangwon, Chungcheng South, and Jeolla South Provinces compared to Seoul was 0.084, 0.036, and 0.194, respectively. The AOR in hospitals with more than 6.75 specialists per 100 beds compared to those with less than 6.75 specialists per 100 beds was 7.514. The AOR in hospitals with more than 17.48 nurse per 100 beds compared to those with less than 17.48 nurse per 100 beds was 3.300. The AOR in hospitals with 50% to 75% bed utilization, 75% to 90% bed utilization and more than 90% bed utilization compared to those with less than 50% bed utilization was 5.428, 9.884, and 10.699, respectively. The AOR in hospitals with one magnetic resonance imaging (MRI) and more than two MRI compared to those with no MRI was 2.018 and 2.942, respectively. Conclusion: This result has showed policies to induce the rise in Grade of Nursing Management Fee among old hospitals and the incentive system for local medical institutions are needed. Also we need to develop a governmental policy for medium-small hospitals with low operation rate of beds and insufficient medical personnel and number of equipment in hospitals.

• Journal of Preventive Medicine and Public Health
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• v.49 no.5
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• pp.329-341
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• 2016

Objectives: The goal of this study was to investigate the short-term effect of ambient air pollution on emergency department (ED) visits in Seoul for asthma according to patients' prior history of allergic diseases. Methods: Data on ED visits from 2005 to 2009 were obtained from the Health Insurance Review and Assessment Service. To evaluate the risk of ED visits for asthma related to ambient air pollutants (carbon monoxide [CO], nitrogen dioxide [$NO_2$], ozone [$O_3$], sulfur dioxide [$SO_2$], and particulate matter with an aerodynamic diameter <$10{\mu}m$ [$PM_{10}$]), a generalized additive model with a Poisson distribution was used; a single-lag model and a cumulative-effect model (average concentration over the previous 1-7 days) were also explored. The percent increase and 95% confidence interval (CI) were calculated for each interquartile range (IQR) increment in the concentration of each air pollutant. Subgroup analyses were done by age, gender, the presence of allergic disease, and season. Results: A total of 33 751 asthma attack cases were observed during the study period. The strongest association was a 9.6% increase (95% CI, 6.9% to 12.3%) in the risk of ED visits for asthma per IQR increase in $O_3$ concentration. IQR changes in $NO_2$ and $PM_{10}$ concentrations were also significantly associated with ED visits in the cumulative lag 7 model. Among patients with a prior history of allergic rhinitis or atopic dermatitis, the risk of ED visits for asthma per IQR increase in $PM_{10}$ concentration was higher (3.9%; 95% CI, 1.2% to 6.7%) than in patients with no such history. Conclusions: Ambient air pollutants were positively associated with ED visits for asthma, especially among subjects with a prior history of allergic rhinitis or atopic dermatitis.

• Journal of Korean Neurosurgical Society
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• v.54 no.6
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• pp.489-495
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• 2013

Objective : To evaluate the efficacy of temozolomide (TMZ) chemotherapy for recurrent anaplastic oligodendroglioma (AO) and anaplastic oligoastrocytoma (AOA). Methods : A multi-center retrospective trial enrolled seventy-two patients with histologically proven AO/AOA who underwent TMZ chemotherapy for their recurrent tumors from 2006 to 2010. TMZ was administered orally (150 to 200 $mg/m^2/day$) for 5 days per 28 days until unacceptable toxicity occurred or tumor progression was observed. Results : TMZ chemotherapy cycles administered was median 5.3 (range, 1-41). The objective response rate was 24% including 8 cases (11%) of complete response and another 23 patients (32%) were remained as stable disease. Severe side effects (${\geq}$grade 3) occurred only in 9 patients (13%). Progression-free survival (PFS) of all patients was a median 8.0 months (95% confidence interval, 6.0-10.0). The time to recurrence of a year or after was a favorable prognostic factor for PFS (p<0.05). Overall survival (OS) was apparently differed by the patient's histology, as AOA patients survived a median OS of 18.0 months while AO patients did not reach median OS at median follow-up of 11.5 months (range 2.7-65 months). Good performance status of Eastern Cooperative Oncology Group 0 and 1 showed prolonged OS (p<0.01). Conclusion : For recurrent AO/AOA after surgery followed by radiation therapy, TMZ could be recommended as a salvage therapy at the estimated efficacy equal to procarbazine, lomustine, and vincristine (PCV) chemotherapy at first relapse. For patients previously treated with PCV, TMZ is a favorable therapeutic option as 2nd line salvage chemotherapy with an acceptable toxicity rate.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.46
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• pp.133-158
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• 2010

Independent guarantee is a creation of the need from the both sides, i.e. the applicant (principal debtor) and the beneficiary (creditor). The former used to have to deposit cash in favor of the beneficiary in case of his default, which laid a burden on his liquidity while the latter still wanted to have the equivalent to cash. Independent guarantee satisfied the both parties by freeing the applicant of a deposit and maintaining the beneficiary's right at the same time. The fact that independent guarantee has three payment mechanisms is not widely known to the public. They are (i) payment on first demand, (ii) payment upon submission of third-party documents, (iii) payment upon submission of an arbitral or court decision. From the applicant's point of view, the order in his favor is (iii), followed by (ii) and (i). As there shouldn't be a case where one party is at a disadvantage against the other, useful insight is being sought for the benefit of the applicant. First, the applicant can offer his intention to provide a payment mechanism (ii) or (iii) rather than (i) if he must deliver it. Second, if the beneficiary still wants to have (i) and the applicant is in a position not to reject it, the latter should thoroughly check any provisions that may work against him later. Third, the applicant could use counterbalancing provisions in underlying contract to cope with protective clauses in the guarantees. Forth, the applicant should review the beneficiary's sincerity to prevent unfair calling risks. The applicant may use an ECA(Export Credit Agency) in his country to which he can transfer not only unfair calling risks, but also political risks. On the other hand, a bank needs to keep the following advice in mind. The foremost important thing for the bank not to forget is that it provides a guarantee as a service provider, not as a responsible party for the feasibility of the project, etc. Credit risk of the applicant should require the greatest attention when issuing a guarantee: the bank should look into the possibility that it can procure immediate reimbursement from its customers after payment to the beneficiary. Second, the applicant's ability to complete the project should be reviewed by checking its track records, techniques and reputation, etc. Third, the bank may also use an ECA to cover the beneficiary's unfair calling risks as well as political risks. In the case of Korea, as Korea Export Insurance Corporation(KEIC) can cover all the risks mentioned above, the bank could use its service called 'Export Bond Insurance.' What's better for the bank is that ECA cover can enhance the bank's asset quality by putting it zero on its risk weighted asset.

• YAKHAK HOEJI
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• v.54 no.4
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• pp.258-269
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• 2010

As people are easy to access the National Health Insurance, medical health service has been increased. It contributed to extend human's average life expectancy and to get better health care. But also increased unnecessary health service or inappropriate drug use. Therefore, DUR (Drug Use Review) is needed to induce appropriate drug use. The purpose of this study is to evaluate outpatient prescriptions by General Practitioner (GP) and Specialized Practitioner, especially indication for ENT referral including common cold which is the frequent indications that have patient see doctor. This study was reviewed retrospectively prescriptions for ENT referral collected at the A pharmacy for ENT Clinic in Cheong-Ju, B pharmacy for GP Clinic in BoEun from Feb 2nd, 2009 to Feb 28th, 2009. Each pharmacy located closed to the each enrolled clinic. The numbers of collected prescriptions were each A pharmacy (n=2501), B pharmacy (n=1343). This study was classified Drug Related Problems (DRPs) those prescriptions had as total 6 groups according to following 6 categories; 1) Unnecessary Drug, 2) Wrong Drug, 3) Low Dose, 4) Overdose, 5) Wrong Instruction, 6) Wrong Combination. In results, Specialized Practitioner's prescriptions had more DRPs than General Practitioner's prescriptions (ENT 155.34% vs GP 130.01%). In detail, Specialized Practitioner's prescriptions had more DRPs in Low Dose (ENT 16.95% vs GP 4.77%), Overdose (ENT 6.72% vs G.P 5.51%), Wrong Instruction (ENT 7.91% vs GP 5.81%), Wrong Combination (ENT 29.31% vs GP 25.09%). These DRPs would be caused from lack of consideration for dosage and drug interaction. General Practitioner's prescriptions had more DRPs in Unnecessary Drug (ENT 70.37% vs GP 78.85%), Wrong drug (ENT 4.12% vs GP 9.98%). These DRPs would be associated with drug selection. This study was assumed that Specialized Practitioner is better prescriber than General Practitioner because Specialized Practitioner complete additional intern and residency training. But, Specialized Practitioner is not always better prescriber than General Practitioner. Furthermore, prescriptions of both Specialized Practitioner and General Practitioner had many problems. In conclusion, It could be cut down the excessive medical expense and expected more efficient medical care by reducing DRPs, thus contributing to the improvement of national health. In order to pharmacist must have good professional ability of pharmacotherapy to help the physician for the drug selection.

• Journal of the korean academy of Pediatric Dentistry
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• v.47 no.4
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• pp.359-367
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• 2020

The aim of this study was to identify the association between candidiasis and early childhood caries and to investigate whether the experience of candidiasis or oral candidiasis before age 1 can be considered as a risk factor for early childhood caries. The database used in this study was provided by Health Insurance Review and Assessment Service. Medical records of children born from January 2010 to December 2012 were obtained, and those without dental records were excluded. Subjects were divided into several groups based on the experience of candidiasis or oral candidiasis before age 6: candidiasis group and non-candidiasis group; oral candidiasis group and non-oral candidiasis group. Another categorization was done according to the experience of candidiasis or oral candidiasis before age 1. The incidence rate of early childhood caries in each group were compared. The prevalence of dental caries in children who have been diagnosed with candidiasis or oral candidiasis before age 6 was significantly different from those who have not experienced candidiasis. Similarly, children who have suffered from candidiasis or oral candidiasis before age 1 had significantly different incidence of caries from the children without candidiasis experience.