• Health Policy and Management
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• v.22 no.2
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• pp.275-296
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• 2012

Graduate School of Public Health, Seoul National University The national health insurance system in Korea is characterized as relatively high out-of-pocket payments, which are the principal source of catastrophic health expenditure (CHE). The objectives of this study are to estimate the incidence of household CHE and to clarify the characteristics that affect the occurrence and recurrence of household CHE using the Seoul Welfare Panel Survey database for 2008 and 2010. Thresholds to estimate CHE were 10% and 20% of the total household income (T/X), and 25% and 40% of the income excluding food share (T/Y). Determinants of the occurrence and recurrence of CHE at the threshold of T/X=10% were analysed using multiple logistic regression models. Out of the 3,665 households that responded in 2008 survey, households with CHE were 12.07% (T/X${\geq}$10%), 5.34% (T/X${\geq}$20%), 6.84% (T/Y${\geq}$25%), and 4.44% (T/Y${\geq}$40%). Risk factors associated with household CHE included living with a spouse, non-Medicaid beneficiary, householder unemployment, low household income, the number of disabled members, poor subjective health, and the number of chronic diseases. A total of 41.78% of households with CHE in 2008 repeatedly experienced CHE in 2010. Risk factors of CHE recurrence included decreased household income and an increase in chronic diseases over the two time periods, the number of members with disability or chronic diseases, and the presence of cancer patients in 2008. Households with lower socioeconomic and health status had a higher financial burden on health care than do their counterpart households. There is a need to enhance society-wide financial protection from health spending among vulnerable citizens in Seoul, particularly, households with low income, disabled members or cancer patients.

• Korea Journal of Hospital Management
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• v.24 no.1
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• pp.48-56
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• 2019

Purpose: As an interest in the elderly medical expenses increases, elderly people are increasingly purchasing indemnity private health insurance. Authors tried to investigate factors of having the indemnity private health insurance among the elderly people aged 65-75 years. Methods: We conducted panel logit regression analysis on 2,465 subjects as of 2016 using Korean Health Panel from 2010 to 2016. The dependent variable was whether to enroll in the indemnity private health insurance. The explanatory variables included socio-demographic characteristics, economic factors, health status, and health behaviors. Findings: As a result of the analysis of factors of purchasing indemnity private health insurances, it was analyzed that people with larger family, educated, pensioner, high household income or no disability were more likely to have indemnity private health insurance. Practical Implications: Considering the results of this study, the factor of purchasing indemnity private health insurance among elderly people were more likely to be their economic than demographic characteristics such as sex, age, and marital status. Policy makers should make efforts to reduce the burden on the elderly medical expense and to improve equity of medical use through institutional improvement such as raising age limit and lowering premium of indemnity private health insurance and expansion of public health insurance.

• Journal of Preventive Medicine and Public Health
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• v.44 no.1
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• pp.32-40
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• 2011

Objectives: This study investigated the gender and age differential effect of major chronic diseases on activity of daily living (ADL) disability. Methods: Surveyfreq and Surveylogistic regression analyses were employed on the 2005 Korean National Health and Nutrition Examination Survey (KNHANES) with a sample of 3,609 persons aged 65 - 89. Results: After adjusting for potential covariates, stroke, among elderly men more so than women, had a 2-3 times greater odds of engendering ADL disability in the 65-69 (p < 0.05) and 70-79 age groups (p < 0.01). In comparison to elderly women, cancer, diabetes, and incontinence in elderly men was associated with a higher risk of ADL disability in the 70 - 79 age group (p < 0.05), and this association was also observed for pulmonary disease in the 80-89 age group. Among elderly women, however, a significant association between incontinence and ADL disability was identified in all three age groups. In addition, this association was found in pulmonary disease and diabetes in elderly women aged 70 - 79 years. Significant gender differences were observed in the association between stroke in the 60 - 79 age group and cancer in the 70 - 79 age group. Conclusions: Age and gender differences were observed in the effect of chronic diseases on ADL disability.

• Women's Health Nursing
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• v.17 no.4
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• pp.407-414
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• 2011

Purpose: The purpose of this study was to compare birth outcomes between Korean women and immigrant women. Methods: Medical records were reviewed retrospectively from 201 immigrant women and 201 Korean women who delivered babies at K women's hospital in U city from January 2006 to December 2009. Maternal outcomes related factors included nationality, age, obstetric history, delivery type, indications of cesarean section, and complications of pregnancy and delivery. Principal neonatal outcomes were birth weight, Apgar scores, and complications of newborns. Results: Immigrant women were younger and had fewer pregnancies, abortions, and surviving children than Korean women. The rate of primary cesarean section and its indication in immigrant women were not significantly different from Korean women. However, immigrant women's newborn were more likely to have low birth weight and meconium staining. Conclusion: The results of this study indicate less equity of immigrant women in women's health care, although immigrant women's babies had lower Apgar score and more meconium staining. Nurses should help immigrant women cope with labor process effectively to prevent adverse health outcomes for their newborns.

• Health Policy and Management
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• v.32 no.3
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• pp.272-281
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• 2022

With the outbreak of coronavirus disease 2019 (COVID-19) pandemic, health policymakers are adopting new policies regarding the issue of immunization disparities, especially for children in low-income communities of color who lack awareness and thereby access to vaccines. The purpose of this paper is to propose an evaluation framework using program theory-based evaluation approach and logic model to analyze and evaluate the immunization disparities in children aged 19-35 months. Data is collected from New York City department of Health and the U.S. Census Bureau for Northern Manhattan Start Right Coalition program which consists of 19,800 children, and the community-provider partnership includes 26 practices and 20 groups. Program theory is used to evaluate this community-based initiative with the logic model which is a visual depiction that illustrations the program theory to all stakeholders. The logic model highlights the resources, activities, outputs, outcomes, and impacts of the program to guide to planners and evaluators and to call attention to the inadequacies or flaws in the operational, implementation and service delivery process of the program in offering a new perspective on the program. This framework adds to the literature on evaluations of immunization disparities in determining whether evaluators can definitively attribute positive immunization outcomes in the community to the program and conclude whether it has potential in expanding or duplicating it to other similar settings, especially in other rural areas of the United States, and abroad, where routine immunization equity gaps are wide due to income, racial and ethnic diversity, and language barrier.

• Journal of Preventive Medicine and Public Health
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• v.53 no.3
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• pp.189-197
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• 2020

Objectives: Our aim was to answer the following questions: (1) Can mental health variance be partitioned to individual and higher levels (e.g., neighborhood and district); (2) How much (as a percentage) do individual-level determinants explain the variability of mental health at the individual-level; and (3) How much do determinants at the neighborhood- or district-level explain the variability of mental health at the neighborhood- or district-level? Methods: We used raw data from the second round of the Urban Health Equity Assessment and Response Tool in Tehran (in 2012-2013, n=34 700 samples nested in 368 neighborhoods nested in 22 districts) and the results of the official report of Tehran's Center of Studies and Planning (in 2012-2013, n=22 districts). Multilevel linear regression models were used to answer the study questions. Results: Approximately 40% of Tehran residents provided responses suggestive of having mental health disorders (30-52%). According to estimates of residual variance, 7% of mental health variance was determined to be at the neighborhood-level and 93% at the individual-level. Approximately 21% of mental health variance at the individual-level and 49% of the remaining mental health variance at the neighborhood-level were determined by determinants at the individual-level and neighborhood-level, respectively. Conclusions: If we want to make the most effective decisions about the determinants of mental health, in addition to considering the therapeutic perspective, we should have a systemic or contextual view of the determinants of mental health.

• Korean Journal of Health Education and Promotion
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• v.25 no.1
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• pp.83-104
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• 2008

Objectives: Community-Based Participatory Research (CBPR) is a kind of health promotion approach to increase social cohesion and sense of community, which has built the collaborated partnership in all phases. This has the co-ownership of research objectives and knowledges produced by residents, and the outcome was taken to enhance community empowerment. This study performed to embody CBPR, which had regulated collective health status approached by social epidemiology. Methods: Reference review had been exercised focused on CBPR books and papers published since 1990. Our interests were aimed at its paradigm and methodological issues. Particularly, we problematized its feasibility in the social and behavioral foundations of pubic health. Results: According to the review, CBPR shared critical understanding and decision-making related to their community development including health status. Therefore, it was strength-based approach in spite of scientific dichotomy. CBPR created social cohesion and community empowerment with all participants, because it sublated contradiction between subjectivism and objectivism. Conclusions: The success of CBPR needs what we so called trust, democracy, collaboration, devotion, and consensus of equity. Despite these factors, CBPR may be a methodological transition to prepare some intervention of health inequality. This is because it does emphasize a mixture of theory and praxis to manage vulnerable people in community.

• Journal of Preventive Medicine and Public Health
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• v.54 no.5
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• pp.301-308
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• 2021

Objectives: Despite its advantages, it is not yet common practice in Korea for researchers to investigate disease associations using spatio-temporal analyses. In this study, we aimed to review health-related epidemiological research using spatio-temporal analyses and to observe methodological trends. Methods: Health-related studies that applied spatial or spatio-temporal methods were identified using 2 international databases (PubMed and Embase) and 4 Korean academic databases (KoreaMed, NDSL, DBpia, and RISS). Two reviewers extracted data to review the included studies. A search for relevant keywords yielded 5919 studies. Results: Of the studies that were initially found, 150 were ultimately included based on the eligibility criteria. In terms of the research topic, 5 categories with 11 subcategories were identified: chronic diseases (n=31, 20.7%), infectious diseases (n=27, 18.0%), health-related topics (including service utilization, equity, and behavior) (n=47, 31.3%), mental health (n=15, 10.0%), and cancer (n=7, 4.7%). Compared to the period between 2000 and 2010, more studies published between 2011 and 2020 were found to use 2 or more spatial analysis techniques (35.6% of included studies), and the number of studies on mapping increased 6-fold. Conclusions: Further spatio-temporal analysis-related studies with point data are needed to provide insights and evidence to support policy decision-making for the prevention and control of infectious and chronic diseases using advances in spatial techniques.

• Journal of Korean Physical Therapy Science
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• v.3 no.4
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• pp.159-169
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• 1996

Every citizen has a right to get the least health care service for their living and should be guaranteed the right of health which is specified in the constitution of Korea. Therefore, health care service should realize the equity and accessibility of service by the equitable distribution which is needed for health care. The objects of this study were the patients who was treated by the physical therapy in health care center(two of them located in cities and others are in agricultural areas). These are the results of our study. First, the age, job, sex and experience of former treatment of objects showed no meaningful statistic difference in the part of convenience of health care center, where as the system of health scurity showed highly meaningful difference. Second, The age, job and system of health care of objects showed no meaningful difference in the part of attitude and appreciation to therapist, where as the experience of former treatment in other center showed highly meaningful difference. Third, The age, job and sex of objects showed no meaningful difference in the part of the appreciation to results of service, where as the system of health scurity and the experience of former treatment in other center showed meaningful difference. To offer the effective physical therapy, the government of province or nation should invest the large amount of financial fund continuously and make the plan of efficient operating system for the physical therapy service room of public health center which is the most nearly located to native citizen. The problem of distance, low reliability to public service, public relation and reliabity should be improved to raise the utility of physical therapy room. And also, the physical therapy room should be opened in health subcenter to offer the condition of the native citizen's healthy life.

• Health Policy and Management
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• v.24 no.1
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• pp.47-55
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• 2014

Background: Korea is considered to have an integrative health system where both western medicine and Korean (traditional) medicine are officially recognized and provided. Although Korean medicine has been covered by National Health Insurance over 20 years, equity in the utilization of Korean medical care has rarely been examined. Methods: We examined medical care utilization and expenditure of outpatient Korean medicine using panel fixed effects model to remove selection bias. Then we compared it with pooled ordinary least square (OLS) model. This study used Korea Health Panel data, which provides accurate information on out-of-pocket health care payment, including non-covered medical services. Results: Principal findings indicate that the frequency of the utilization of Korean medicine is related with unobservable individual choices different from western medicine, so the panel fixed effect model is appropriate. But pooled OLS model is better fitted for the expenditure of Korean medicine, after controlling for western medical care expenditure. After adjusting for the selection bias, socioeconomic status (income, education) was significantly associated with the expenditure of Korean medicine, but not with the frequency of the utilization of Korean medicine. Conclusion: This study shows that expenditure of Korean medicine utilization is inequitable across socioeconomic groups, which implies that health insurance coverage of Korean medicine is not sufficient.