• Journal of Environmental Health Sciences
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• v.47 no.5
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• pp.379-383
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• 2021

This paper discussed environmental health policies for the past and coming decade by reviewing the First Comprehensive Environmental Health Plan (2011~2020) and introducing the Second Comprehensive Environmental Health Plan (2021~2030). The major achievement of the First Comprehensive Environmental Health Plan was the establishment of receptor-oriented environmental health policies. However, the main limitations were insufficient policy support for relief and/or recovery from environmental pollution damage and low public awareness of environmental health policies. The Second Comprehensive Environmental Health Plan presents the following major policy tasks: establish an omnidirectional environment health investigation and monitoring system, provide customized environmental health services, improve the environmental health damage relief and recovery system, and promote regional environmental health policies. The Second Plan has a clear distinction from the First Plan in that it expands the field of environmental health from the prevention and management of environmental risk factors to proactive damage response and recovery, which will effectively contribute to alleviating the burden of environmental disease.

• Journal of Environmental Health Sciences
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• v.30 no.3
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• pp.283-292
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• 2004

Valid evaluation of community reaction to road-traffic noise exposure is important for the policy making and quality of life. The purpose of this study is to evaluate the relationship between community reaction and nighttime road-traffic noise. The study measured nighttime roadside noise caused by high traffic which is greater than LAeq(22:00-07:00) 65dB(A) and lower than 65dB(A) at Chonju city, from March to April, 2003. Three hundred sixty seven subjects, aged from 20 to 65, were selected from those who are residing close to the major roads. They were asked to answer the questions regarding noise source, stress(PWI-SF), annoyance, disturbance of specific activity, disturbance of sleep, somatic symptom, and four suggested confounding factors. The relationship between annoyance, somatic symptom and noise exposure was not significant. Adjusted odds ratio(95% C.I.) for disturbance of communication　 and disturbance of attention and rest　 were 1.59(1.03-2.71), 1.64(1.06-2.81), respectively. On the other hand sleep disturbance　 was indicated as 1.34(0.77-2.32). The results suggested that federal policy-making about road-traffic noise should consider community reaction evaluated by various perspective including annoyance, disturbance of specific activity, disturbance of sleep, and confounding factors.

• Journal of Korean Public Health Nursing
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• v.18 no.2
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• pp.218-224
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• 2004

This study was conducted to explain adolescents' smoking behavior using Health Belief Model. A cross-sectional study design was used to analyze characteristics and factors that influence smoking behavior among Korean adolescents. A total of 1.535 adolescents attending 21 high schools in one district of Seoul participated in the study. The results indicated that perceived susceptibility, severity, benefits, and barriers were significant in predicting smoking behavior of adolescents. Likewise, the degree of juvenile delinquency, gender, the amount of pocket money, and having smoking parent(s) and friend(s) significantly affect smoking behavior of adolescents. Based on the study results, it is recommended to incorporate HBM components in smoking cessation programs, and to include parents and friends in smoking prevention and cessation programs for high school students in Korea.

• Journal of Preventive Medicine and Public Health
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• v.48 no.4
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• pp.195-202
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• 2015

Objectives: Receiving proper dental care plays a significant role in maintaining good oral health. We investigated the relationship between regional deprivation and dental care utilization. Methods: Multilevel logistic regression was used to identify the relationship between the regional deprivation level and dental care utilization purpose, adjusting for individual-level variables, in adults aged 19+ in the 2008 Korean Community Health Survey (n=220 258). Results: Among Korean adults, 12.8% used dental care to undergo examination and 21.0% visited a dentist for other reasons. In the final model, regional deprivation level was associated with significant variations in dental care utilization for examination (p<0.001). However, this relationship was not shown with dental care utilization for other reasons in the final model. Conclusions: This study's findings suggest that policy interventions should be considered to reduce regional variations in rates of dental care utilization for examination.

• Health Policy and Management
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• v.25 no.3
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• pp.207-220
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• 2015

Background: The purpose of this exploratory study is to explain where, when and how the introduction of user fee system works in low and middle income countries using context, mechanism, and outcome configuration. Methods: Considering advanced research in realist review approach, we made a review process including those following 4 steps. They are identifying the review question, initial theory and mechanism, searching and selecting primary studies, and extracting, analyzing, and synthesizing relevant data. Results: User fee had a detrimental effect on medical utilization in low and middle income countries. Also previous and current interventions and community participation were critical context in user fee system. Those contexts were associated with intervention initiation and recognition and coping strategies. Such contexts and mechanisms were critical explanatory factors in medical utilization. Conclusion: User fee is a series of interventions that are fragile and dynamic. So the introduction of user fee system needs a comprehensive understanding of previous and new intervention, policy infrastructure, and other factors that can influence on medical utilization.

• Health Policy and Management
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• v.30 no.2
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• pp.231-244
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• 2020

Background: As the population is aging, chronic diseases and depression are becoming the main problems in a country's healthcare system. In this study, we aimed to explore the associations between chronic diseases and depression among the elderly in South Korea. Methods: We analyzed 9,975 (men, 4,147; women, 5,828) respondents obtained from the 2014 National Survey of Living Conditions and Welfare Needs of Korean Older Persons. Our dependent variable was either 1 or 0 according to whether a respondent had depression or not, where depression was defined when the Short Form of Geriatric Depression Scale score was 8 or more points. Variables of interest were 24 types of chronic diseases and covariates included various socio-demographic and health behavior characteristics. We performed Rao-Scott chi-square tests and hierarchal logistic regression analyses by gender, reflecting the characteristics of the survey. Results: A significant difference was found in the proportion of having depression between genders (men 18.9% vs. women 23.4%). According to fully adjusted, multivariable analyses, for elderly men, relative to those without any chronic disease, the odds ratio of depression was 1.56 (95% confidence interval [CI], 1.10-2.22) in the stroke patients group and 1.82 (95% CI, 1.01-3.25) in the osteoporosis patients group. For elderly women, the odds ratio was 1.96 (95% CI, 1.28-3.00) in the fracture/dislocation and aftereffects patients group and 1.30 (95% CI, 1.03-1.64) in the group of patients with other diseases. Conclusion: Even after being adjusted for diverse characteristics, some chronic diseases were significantly associated with depression in the elderly and the association differed between genders. Therefore, public health and medical interventions are needed to manage such chronic diseases together with curing depression symptoms.

• Journal of Preventive Medicine and Public Health
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• v.52 no.1
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• pp.41-50
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• 2019

Objectives: The aim of this study was to investigate cancer patients' utilization of tertiary hospitals in Seoul before and after the benefit expansion policy implemented in 2013. Methods: This was a before-and-after study using claims data of the Korean National Health Insurance Service from 2011 to 2016. The unit of analysis was inpatient episodes, and inpatient episodes involving a malignant neoplasm (International Classification of Diseases, Tenth Revision codes: C00-C97) were included in this study. The total sample (n=5 565 076) was divided into incident cases and prevalent cases according to medical use due to cancer in prior years. The tertiary hospitals in Seoul were divided into two groups (the five largest hospitals and the other tertiary hospitals in Seoul). Results: The proportions of the incident and prevalent episodes occurring in tertiary hospitals in Seoul were 34.9% and 37.2%, respectively, of which more than 70% occurred in the five largest hospitals in Seoul. Utilization of tertiary hospitals in Seoul was higher for inpatient episodes involving cancer surgery, patients with a higher income, patients living in areas close to Seoul, and patients living in areas without a metropolitan city. The utilization of the five largest hospitals increased by 2 percentage points after the policy went into effect. Conclusions: The utilization of tertiary hospitals in Seoul was concentrated among the five largest hospitals. Future research is necessary to identify the consequences of this utilization pattern.

• Health Policy and Management
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• v.31 no.3
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• pp.280-291
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• 2021

Background: Based on the fact that the Korea Medical Dispute Mediation and Arbitration Agency is a public institution established by social demands for medical disputes, this study reviews the publicness of public organization and discusses its policy implications. Methods: Through Moore's strategic triangle, which consists of legitimacy and support, public value and operational capacity, the process of creating public value is examined. For the analysis, case studies were conducted using related literature data from 2012, when the agency was established, to the present. Results: As a result of the analysis, first, the related law examined in the operational capability has been revised dozens of times, but the revised law has its own contradictions and limitations. The human resource system is also being improved, but there is a problem with the fairness and reliability of the arbitration process, especially due to the limitations of the appraiser system. Second, in terms of legitimacy and support, a regional gap occurred despite efforts to improve accessibility through the expansion of the organization. And the arbitration agency failed to reconcile conflicts caused by stakeholders' perception of each other as a trade-off relationship. Third, the public value result shows that, despite many explicit (statistical) achievements, citizens' use of the past dispute resolution means (litigation) has not decreased. Likewise, the perception of value makers (citizens) is important for creating public value as an invisible result, but it has not yet been formally investigated, so the performance can not be recognized. Conclusion: While the organization's efforts for continuous change and improvement are encouraging, it is not perceived as a better means of resolving disputes and improving quality of services. Therefore, it is necessary to reconsider the institutional design centered on value creators.

• Health Policy and Management
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• v.27 no.3
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• pp.247-255
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• 2017

Background: South Korea has experienced problems with excessive pharmaceutical expenditures. In 2010, the South Korean government introduced an outpatient prescription incentive program to effectively manage pharmaceutical expenditures. Therefore, we examined the relationship between the outpatient prescription incentive program and pharmaceutical expenditures. Methods: We used data from the Korean National Health Insurance claims database, which included medical claims filed for 22,732 clinics from 2011-2014 to evaluate associated pharmaceutical expenditures. We performed multiple regression analysis and Poisson regression analysis using generalized estimating equation models to examine the associations between outpatient prescription incentives and the outcome variables. Results: The data used in this study consisted of 123,392 cases from 22,372 clinics (average 5.4 periods follow-up). Clinics that had received outpatient prescription incentives in the last period had better cost saving and Outpatient Prescribing Costliness Index (OPCI) (received: proportion of cost saving, ${\beta}=6.8179$; p-value < 0.0001; OPCI, ${\beta}=-0.0227$; p-value < 0.0001; reference = non-received). Moreover, these clinics had higher risk in the provision of outpatient prescription incentive (relative risk, 2.772; 95% confidence interval, 2.720 to 2.824). The associations were higher in clinics that had separate prescribing and dispensing programs, or had professional staff. Conclusion: The introduction of an outpatient prescription incentive program for clinics effectively managed problems with rapid increases of pharmaceutical expenditures in South Korea. However, the pharmaceutical expenditures still increased in spite of the positive impact of the outpatient prescription incentive program. Therefore, healthcare professionals and health policy makers should develop more effective alternatives (i.e., for clinics without separate prescribing and dispensing programs) based on our results.

• Health Policy and Management
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• v.13 no.4
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• pp.28-47
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• 2003

The purpose of this study was to assess the user's satisfaction of health care service in public health centers in Busan. The study respondents were 212, those who visited health centers for health care service. Data were collected in July 2002 by using SERVQUAL(comprehensive service quality measurement scale) and 3 open questions for more details about service satisfaction and the needs for health care service. SERVQUAL has 5 dimensions； tangibles, reliability, responsiveness, assurance and empathy. The results were as follows ： 1. The users reported more satisfaction at 'just service cost', 'convenient service procedure' and 'clean physical environment' at SERVQUAL. Among them the highest rated item was 'service cost'. And the less satisfaction items were 'understanding and individual concerns about service users', 'medical equipment' and 'health center facilities'. 2. There were no statistical differences by general characteristics except for the kind of services rendered. Those who visited for physical examinations and laboratory tests reported lower satisfaction than any other groups. 3. At the open questions, the respondents expressed that they were satisfied with the low service cost, kindness of employee and clean environment. But they criticized the old facilities and worn medical equipment, in addition to the less than kind attitudes. These strengths and weaknesses of health center's service could be applied for planning of customer­centered health care service.