• Title/Summary/Keyword: chronic disease/disability

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The Association between Health Examination and Personal Medical Cost through Panel Survey (건강검진이 개인 의료비지출에 미치는 영향)

  • Lee, Hwan Hyung;Park, Jae Yong
    • Health Policy and Management
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    • v.24 no.1
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    • pp.35-46
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    • 2014
  • Background: This paper describes the relationship and effect of health examination on personal medical cost by identifying the difference of the cost for medical care in physician visit between the population without and with health examination. Methods: After classifying into three cohorts in which, independent variables were designed according to the Andersen's behavioral model, the association of personal medical cost for medical care and prescription drugs which is dependent variable was analyzed by t-test and Mann-Whitney test for description and gamma regression model for inference. Results: In personal average medical cost, the population with health examination paid significantly more than without health examination, 11.6% more in cohort 2008, 26.6% more in cohort 2009, and 48.0% more in combined cohort. The odds ratio on medical expenditure of outpatients with health examination was 1.067, 1.126, 1.398 significantly in cohort 2008, 2009, and combined cohort respectively, comparing to the group without health examination. In independent variables, that is female, the elderly, never married, non-working, non-metropolitan, the higher family income, the smaller family size, people with disability, the people with chronic disease, and people with health examination have significantly being paid more tendency showing positive association with medical cost. Conclusion: This result showed that medical expenditure in physician visit has been increased after taking a health examination. Therefore reasonable limitation of getting preventive medical service is suggested to avoid medical shopping around and reduce being repeated health examination by unifying control to find out easily the clinical results from various medical facilities.

Estimation of Productivity Losses due to Smoking (흡연으로 인한 생산성 손질 추정)

  • 김태현;문옥륜;김병익
    • Health Policy and Management
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    • v.10 no.3
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    • pp.169-187
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    • 2000
  • Cigarette smoking has been identified as the most important source of preventable morbidity and premature mortality (WHO, 1995), The prevalence of smoking among men is very high in Korea. This study estimated productivity losses due to smoking in Korea, 1997. The derivation of cost estimates for mortality, disability, hospitalization and use of physician services related to cigarette smoking is bas 어 on the calculation of attributable fractions suggested by MacMahon and Cole and Smoking-Attributable Mortality, Morbidity, and Economic Cost(SAMMEC) software. To estimate the number of deaths from neoplastic, cardiovascular, respiratory diseases associated with cigarette smoking, estimates for adults(aged 20 years and over) were based on 1997 mortality data, 1995 data on smoking prevalence from Korea Institute for Health and Social Affairs. Smoking-attributable indirect morbidity cost data were obtained from the National Federation of Medical Insurance. As the result of cost estimation, these productivity losses were 336-430 billion won. During 1997, 8,620-10,804 deaths were attributed to smoking. Cigarette smoking resulted in 133,991-169,422 Years of Potential Life Lost (YPLL) to life expectancy. For smoking -attributable indirect mortality costs, the present value of future earnings(PVFE) for the age at death are 299-384 billion won. Smoking-attributable indirect morbidity costs, the costs of lost productivity for persons who are disabled by smoking-related chronic diseases are 37-46 billion won. In this study the productivity losses due to smoking were restricted to the health effects of smoking. It is possible that these costs were underestimated with the limitation of the data. Smoking is the leading preventable cause of illness and death. The results of this study can be used as elementary data for antismoking policy.

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Analysis of the Health Expenditure and Medical Usage Difference of the Baby Boomers between Male and Female: Depression as a Mediators (베이비붐세대의 남녀 간 의료비 지출 및 의료이용 차이: 우울을 매개변수로)

  • Jeong, Ji Yun;Jeong, Jae Yeon;Cha, Sun Jung;Lee, Hae Jong
    • Health Policy and Management
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    • v.29 no.2
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    • pp.160-171
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    • 2019
  • Background: This study purposed to compare the difference on medical utilization and health expenditure of baby boomer generation by depression between gender. Methods: Korea Welfare Panel Survey 2016, provided by the Korea Institute for Health and Social Affairs, was used for the analysis. For the research, we used the two-part model, yes or no of use (part 1), and frequency of use (part 2) for medical utilization. The dependent variables are the whether or not to use of hospitalization services, outpatient services, length of stay, outpatient service visits, and health expenditure. And the independent variables are used as the predisposing (education, spouse presence), enabling (insurance type, private insurance, economic activity, income), and need (chronic disease, self-rated health, disability) factors in the Andersen behavior model. Depression was used as intervening variables. Structural equation model and multiple group analysis by gender were used. Results: There were differences in the medical care usage and cost between men and women in baby boomer. For men, mediating effects of depression were present at the hospitalization (yes/no), length of stay, and health expenditure. On the other hand, for women, the mediating effect of depression was found only at the outpatient visits. Specially, depression was working at the medical services by the different way between gender. The size of effect (multiple group analysis) was affected by significant differences between men and women. Conclusion: This study found that the mediating effect of depression is increased medical usage and health expenditure and the effect factors are different by gender. Therefore, it is necessary to establish a medical care policy considering the socio-economic characteristics of baby boomers.

Poor People and Poor Health: Examining the Mediating Effect of Unmet Healthcare Needs in Korea

  • Kim, Youngsoo;Kim, Saerom;Jeong, Seungmin;Cho, Sang Guen;Hwang, Seung-sik
    • Journal of Preventive Medicine and Public Health
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    • v.52 no.1
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    • pp.51-59
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    • 2019
  • Objectives: The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated. Methods: Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables. Results: The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and self-rated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model. Conclusions: The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.

Knowledge Structure of Posttraumatic Growth Research: A Network Analysis (네트워크 분석을 통한 외상 후 성장 지식구조 연구)

  • Shin, JooYeon;Kwon, Sunyoung;Bae, Ka Ryeong
    • Journal of Industrial Convergence
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    • v.20 no.10
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    • pp.61-69
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    • 2022
  • Posttraumatic growth literature has been rapidly expanding in multiple academic disciplines. Purpose of this study is to examine the knowledge structure of posttraumatic growth utilizing a network analysis. Papers published between 1996 and 2018 were searched on the Web of Science, focusing on terms related to posttraumatic growth. One thousand six-hundred and fifty-nine keywords were published 6,343 times in 1,780 papers; thus, a total of 322 keywords (5,195 appearances) were selected for the final analysis. The network analysis and network visualization tool used were NodeXL and PFnet, respectively. The keywords which appeared the most frequently were "Posttraumatic growth," followed by "Posttraumatic Stress Disease," "Cancer," and "Trauma." A total of 322 nodes have been reduced to 175 nodes and divided into a total of five groups. The five groups were "Posttraumatic Growth in Cancer, Chronic/Serious Illness, and Disability," "Posttraumatic Growth-related Psychological Variables and Psychotherapy," "Posttraumatic Growth in the Context of Death," "Cognitive Mechanisms of Posttraumatic Growth," and "Vicarious Posttraumatic Growth." This study provides a systematic overview on the knowledge structure of posttraumatic growth by quantitatively network analysis.

Depression and affecting factors in middle-aged women with disabilities (중ㆍ고령 장애 여성의 우울과 영향 요인)

  • Ye-Soon, Kim;Minjae, Jeon;Jinjoo, Min;Seung Hee, Ho
    • The Journal of Korean Society for School & Community Health Education
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    • v.23 no.4
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    • pp.49-61
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    • 2022
  • Objectives: It is reported that the depression of women with disabilities is higher than that of men with disabilities and people with disabilities. Therefore, the purpose of this study is to identify the depression level and influencing factors of middle-aged women with disabilities. Method: For this study, the 2020 survey on the disabled was used. The subjects were 2,546 middle-aged and disabled women over the age of 40 who responded to the survey. For data analysis, SPSS Window 26.0 program was used. Descriptive analysis, chi-square test, and multiple logistic analysis were performed to identify factors affecting depression in middle-aged women with disabilities. Results: In this study, marital status, subjective economic status, disability type, subjective health status, subjective obesity, chronic disease, exercise, stress and suicidal ideation, and self-going ability variables of middle-aged and elderly women with disabilities were found to be related to depression. Factors affecting the depression of middle-aged women with disabilities were analyzed to be marital status, smoking, stress, and suicidal ideation variables. Conclusion: Stress and suicidal ideation should be reduced to effectively reduce depression and improve depression in middle-aged and elderly women with disabilities. And the development and application of health education and programs that can promote mental health are required.

Effects of the Patellar Tendon Strap on Kinematics, Kinetic Data and Muscle Activity During Gait in Patients With Chronic Knee Osteoarthritis

  • Eun-Ji Lee;Ki-Song Kim;Young-In Hwang
    • Physical Therapy Korea
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    • v.30 no.2
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    • pp.110-119
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    • 2023
  • Background: Osteoarthritis is a common condition with an increasing prevalence and is a common cause of disability. Osteoarthritic pain decreases the quality of life, and simple gait training is used to alleviate it. Knee osteoarthritis limits joint motion in the sagittal and lateral directions. Although many recent studies have activated orthotic research to increase knee joint stabilization, no study has used patellar tendon straps to treat knee osteoarthritis. Objects: This study aimed to determine the effects of patellar tendon straps on kinematic, mechanical, and electromyographic activation in patients with knee osteoarthritis. Methods: Patients with knee osteoarthritis were selected. After creating the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), leg length difference, Q-angle, and thumb side flexion angle of the foot were measured. Kinematic, kinetic, and muscle activation data during walking before and after wearing the orthosis were viewed. Results: After wearing the patellar tendon straps, hip adduction from the terminal stance phase, knee flexion from the terminal swing phase, and ankle plantar flexion angle increased during the pre-swing and initial swing phases. The cadence of spatiotemporal parameters and velocity increased, and step time, stride time, and foot force duration decreased. Conclusion: Based on the results of this study, the increase in plantar flexion after strap wearing is inferred by an increase due to neurological mechanisms, and adduction at the hip joint is inferred by an increase in adduction due to increased velocity. The increase in cadence and velocity and the decrease in gait speed and foot pressure duration may be due to joint stabilization. It can be inferred that joint stabilization is increased by wearing knee straps. Thus, wearing a patellar tendon strap during gait in patients with knee osteoarthritis influences kinematic changes in the sagittal plane of the joint.

The Effect of Long-Term Care Ratings and Benefit Utilization Characteristics on Healthcare Use (노인장기요양 등급 및 급여 특성이 의료이용에 미치는 영향)

  • Kang Ju Son;Seung-Jin Oh;Jong-Min Yoon
    • Health Policy and Management
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    • v.33 no.3
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    • pp.295-310
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    • 2023
  • Background: The long-term care (LTC) group has higher rates of chronic disease and disability registration compared to the general older people population. There is a need to provide integrated medical services and care for LTC group. Consequently, this study aimed to identify medical usage patterns based on the ratings of LTC and the characteristics of benefits usage in the LTC group. Methods: This study employed the National Health Insurance Service Database to analyze the effects of demographic and LTC-related characteristics on medical usage from 2015 to 2019 using a repeated measures analysis. A longitudinal logit model was applied to binary data, while a linear mixed model was utilized for continuous data. Results: In the case of LTC ratings, a positive correlation was observed with overall medical usage. In terms of LTC benefit usage characteristics, a higher overall level of medical usage was found in the group using home care benefits. Detailed analysis by medical institution classification revealed a maintained correlation between care ratings and the volume of medical usage. However, medical usage by classification varied based on the characteristics of LTC benefit usage. Conclusion: This study identified a complex interaction between LTC characteristics and medical usage. Predicting the requisite medical services based on the LTC rating presented a challenge. Consequently, it becomes essential for the LTC group to continuously monitor medical and care needs, even after admission into the LTC system. To facilitate this, it is crucial to devise an LTC rating system that accurately reflects medical needs and to broaden the implementation of integrated medical-care policies.

An Operations Study on a Home Health Nursing Demonstration Program for the Patients Discharged with Chronic Residual Health Care Problems (추후관리가 필요한 만성질환 퇴원환자 가정간호 시범사업 운영 연구)

  • 홍여신;이은옥;이소우;김매자;홍경자;서문자;이영자;박정호;송미순
    • Journal of Korean Academy of Nursing
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    • v.20 no.2
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    • pp.227-248
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    • 1990
  • The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptible to our society. Thus, the study was designed to demonstrate the effectiveness of home heath care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute(PRICOR) which constitutes 3 stages of research : namely, problem analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development asa solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypotheses set forth for the study ; 1. Total expenditures for the period of study were not reduced for the experimental group, however, since the cost per hospital visit is about 4 times as great as the cost per home visit, the effect of cost saving by home care will become a reality as home care replaces part of the hospital visits. 2. The effect on the rate of readmission and job retention was found to be statistically nonsignificant though the number of readmission was less among the experimental group receiving home care. 3. The effect on compliance to the health care regime was found to be statistically significant at the 5% level for hepatopathic and diabetic patients. 4. Education on diet, rest and excise, and medication through home care had an effect on improved liver function test scores, prevention of complications and self - care knowledge in hepatopathic patients at a statistically significant level. 5. In hemiplegic patient, home care had an effect on increased grasping power at a significant level. However. there was no significant difference between the experimental and control groups in the level of compliane, prevention of complications or in self-care practices. 6. In diabetic patients, there was no difference between the experimental and control groups in scores of laboratory tests, appearance of complications, and self-care knowledge or self -care practices. The above findings indicate that a home care program instituted for such short term as 6 months period could not totally demonstrate its effectiveness at a statistically significant level by quantitative analysis however, what was shown in part in this analysis, and in the continuous consultation sought by those who had been in the experimental group, is that home health care has a great potential in retarding or preventing pathological progress, facilitating rehabilitative and productive life, and improving quality of life by adding comfort, confidence and strength to patients and their families. For the further studies of this kind with chronic patients it is recommended that a sample of newly diagnosed patients be followed up for a longer period of time with more frequent observations to demonstrate a more dear- cut picture of the effectiveness of home care.

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The Trend in Household Catastrophic Medical Expenditure according to Healthcare Coverage Types and Its Associated Factors (의료보장 형태에 따른 연간 가구 과부담 의료비 지출 추이와 관련요인)

  • Lee, Seon Hwa;Kam, Sin;Lee, Won Kee
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.16 no.6
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    • pp.4067-4076
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    • 2015
  • This study aims to examine the trend in household catastrophic medical expenditure according to the healthcare coverage types and its associated factors based on the raw data of the Korean Health Panel over the years 2008 to 2011. Correspondence analysis was used to investigate the trend in the incidence rates of annual catastrophic medical expenditure and generalized estimating equation to examine the factors influencing the incidence of catastrophic medical expenditure. The annual mean incidence rates of household catastrophic medical expenditure were 25.1%, 15.4%, 10.1%, 5.4% and 3.2% in the threshold levels of 10%, 15%, 20%, 30%, and 40% respectively. The incidence rate of household catastrophic medical expenditure was higher when the total annual household income was lower, the education level of the householder was lower, the healthcare coverage type was National Health Insurance, the householder had disability, the age of the householder was older, the number of household members was smaller, the subjective health status of household members was lower, and the prevalence rate of the chronic disease of the household was higher(p<0.05). Therefore, a policy for vulnerable households with older or patient members of chronic diseases should be established.