• Journal of Hospice and Palliative Care
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• v.22 no.3
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• pp.105-116
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• 2019

Purpose: Pediatric palliative care (PPC) is emphasized as standard care for children with life-limiting conditions to improve the quality of life. In Korea, a government-funded pilot program was launched only in July 2018. Given that, this study examined various PPC delivery models in other countries to refine the PPC model in Korea. Methods: Target countries were selected based on the level of PPC provided there: the United Kingdom, the United States, Japan, and Singapore. Relevant literature, websites, and consultations from specialists were analyzed by the integrative review method. Literature search was conducted in PubMed, Google, and Google Scholar, focusing publications since 1990, and on-site visits were conducted to ensure reliability. Analysis was performed on each country's process to develop its PPC scheme, policy, funding model, target population, delivery system, and quality assurance. Results: In the United Kingdom, community-based free-standing facilities work closely with primary care and exchange advice and referrals with specialized PPC consult teams of children's hospitals. In the United States, hospital-based specialized PPC consult teams set up networks with hospice agencies and home healthcare agencies and provide PPC by designating care coordinators. In Japan, palliative care is provided through several services such as palliative care for cancer patients, home care for technology-dependent patients, other support services for children with disabilities and/or chronic conditions. In Singapore, a home-based PPC association plays a pivotal role in providing PPC by taking advantage of geographic accessibility and cooperating with tertiary hospitals. Conclusion: It is warranted to identify unmet needs and establish an appropriate PPD model to provide need-based individualized care and optimize PPC in South Korea.

• 대한예방의학회:학술대회논문집
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• 2005.10a
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• pp.330-330
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• 2005

• Health Policy and Management
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• v.24 no.4
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• pp.357-366
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• 2014

Background: The objective of this study was to evaluate the efficiency of an emergency ambulance system and to investigate socio-economic and clinical characteristics associated with emergency ambulance service. Methods: Based on 2011 Korea health panel, unmet need and inappropriate use of emergency ambulance service were measured by Gibson in 1977. Furthermore, the factors associated with unmet need and inappropriate use of emergency ambulance service were identified by Fisher's exact tests and multiple logistic regression models. Results: Unmet need, defined as the proportion of emergency patients who clinically need ambulance transportation but do not receive it, was found to be 59.8%. Inappropriate use, defined as the proportion of emergency patient receiving ambulance care who did not clinically need it, was found to be 37.2%. There were statistically significant differences between appropriate and inappropriate groups in overall variables of socio-economic and clinical characteristics. Specifically, gender, age, relationship to household, and reasons of visiting emergency department (accident/disease) were statistically significant factors associated with appropriate use of emergency ambulance service. Conclusion: Unmet ambulance need is a useful measure for patients needs assessment, and inappropriate ambulance use is a valid criteria in judging the efficiency of emergency ambulance system. To improve and understand emergency ambulance system, unmet need and inappropriate use of emergency ambulance service should be more concerned.

• Journal of Korean society of Dental Hygiene
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• v.20 no.5
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• pp.571-580
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• 2020

Objectives: This study aimed to investigate the factors associated with unmet dental needs among adults with activity limitations. Methods: Data were obtained from the seventh Korean National Health and Nutrition Examination Survey (KNHANES). The final sample consisted of 945 adults aged 20 years or older with limited activity. Logistic regression analysis was used to examine the influence of predisposing, enabling, and need factors on unmet dental needs. Results: The proportion of adults with unmet dental needs during the last year was 52.2% in the middle-aged group and 45.5% in the older adult group. Higher household income was associated with fewer unmet dental needs in both groups. In the older adult group, married people were less likely to have unmet dental needs. In the middle-aged group, adults who perceived their oral health as poor were more likely to have unmet dental needs. Conclusions: All three factors (predisposing, enabling, and need) were found to be associated with unmet dental needs among adults with activity limitations. Special efforts should be made to improve access to dental care services for middle-aged adults with activity limitations.

• Journal of Korean Academy of Oral Health
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• v.42 no.4
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• pp.152-158
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• 2018

Objectives: The purpose of this study was to investigate effective predictive factors of the persistence of unmet dental care needs. Methods: Data were obtained from the Korea Health Panel studies of 2011 and 2015, and 4,406 subjects, aged 18 years or older, were included in this study. Of these subjects, those who persistently experienced unmet dental care needs over the three-year period were identified. Panel logistic regression analyses were conducted to identify socio-demographic and health-related factors associated with the persistence of unmet dental care needs in two groups, those aged between 18-64 years and over 65 years. Results: Approximately 12% of subjects showed a persistence in unmet dental care needs. Marital status, education level, household income, type of health insurance, and self-rated health status all significantly correlated with the persistence of unmet dental care needs in both age groups. Conclusions: Efforts should be made to identify factors related to the persistence of unmet dental care needs in order to improve patient accessibility to dental care services.

• Journal of Preventive Medicine and Public Health
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• v.22 no.4 s.28
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• pp.578-590
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• 1989

This study was conducted to assess the equity in the regional insurance scheme through analysis of the computerized data from one regional insurance society and National Federation of Medical Insurance. We analysed the insurance contribution and benefit by the classes based on total and income-related contribution per household. The major findings of this study are as follows : 1. The average proportion of income-related contribution among the total was 39.2% and the upper classes show higher proportion of the income-related contribution. 2. The upper classes show higher health care utilization rate than the lower classes. It suggests that the lower classes have relatively large unmet medical needs. 3. The analysis through the Lorenz curve reveals that there exists transference of contributions from the upper to lower classes. But the cumulative percentage of insurance benefit is smaller than that of the number of the insured. It implies that regional medical insurance scheme in Korea has still some inequity in the context of social security principles.

• Health Policy and Management
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• v.25 no.1
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• pp.11-21
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• 2015

Background: The objective of this research is to investigate and provide analysis of the economic participatory change affecting the unmet needs of health care in Korean adults. Methods: We used Korea health panel 4th and 5th data of 10,261 adults. The method of investigation is threefold. First, We identified the regional factors affecting unmet needs of health care. Second, we analyzed the effect of economic participatory change as it affects the unmet needs of health care. Third, we also investigated whether there were discernable differences between the age subgroups. Results: It was determined that influencing factors included sex, education, economic level, and health status. And after the subgroup analysis of age, we found that the economic participatory change was associated with the economical unmet needs of health care especially for those over 40 years of age. Also the population are facing unemployment enduring particular economic hardship in meeting their medical needs. Conclusion: This study finds that there are some policy recommendations for the sake of medical service equality. Medical welfare policy for those 40 years of age and older has been identified as an area that needs improvement. And considering that those 40 years of age and older are facing unemployment enduring particular economic hardship in meeting their medical needs, this study finds a need for government sponsored medical stipends or subsidizing of medical premiums, co-payment, and other fees.

• Health Policy and Management
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• v.24 no.1
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• pp.24-34
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• 2014

Background: Bankrupted households have recently been increased due to excessive medical expenditure in Korea. They have not been protected from economic risk when household's member has severe diseases that need a lot of money for treatment. Purpose of this study examines policy effect by comparing unmet needs' change of policy object households and non-object groups. Methods: We used Korea Health panel 2nd 4th data collected by Korea Institute for Health and Social Affairs and National Health Insurance Service. Analysis subjects were 381 households (pre-policy) and 393 households (post-policy) that had cancer and cardiovascular and cerebrovascular diseases. Since it was major concern that estimates benefit strengthening policy started by certain time, we setup comparing households which had diabetes, hypertension disease. Comparison subjects were 393,247 households, respectively and we evaluated policy effect using difference in difference (DID) model. Results: Although unmet needs of policy object households were higher than non-object groups, policy execution variable affected negative direction. But interaction-term which shows pure effect of policy was not statistically significant. We utilized multi-DID model to examine factors affecting unmet needs causes. Copayment assistance policy did not significantly affect households that responded to 'economic reason,' and 'no have time to visit' for unmet needs causes. Conclusion: The second copayment assistance policy did not significantly give positive effect to beneficiary households than non-beneficiary groups. When we consider that primary purpose of public insurance guarantee high medical expenditure occurred by unexpected events, it needs to deliberate on switch of benefit strengthening policy that can assist vulnerable people. Also, we suggest that government forward a policy covering non-reimbursable medical expenses as well as switch of benefit strengthening direction because benefit policy do not affect non-covered medical cost which accounts for quarter of total health expenditure.

• Health Policy and Management
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• v.30 no.1
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• pp.37-49
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• 2020

Background: Unmet healthcare needs have many advantages for measuring inequalities in healthcare use. However, the existing indicator is difficult to capture the reality of unmet healthcare needs sufficiently and is not quite appropriate in comparing regional inequality. The purpose of this study is to critically analyze the utilization of the unmet healthcare need indicator for regional healthcare inequalities research. Methods: We used the level of healthcare accessibility and healthcare need to categorize the regions that are known to cause differences in healthcare utilization between regions and verified how existing unmet healthcare need indicator is distributed at the regional level. Results: Four types of regions were classified according to the high and low levels of healthcare needs and accessibility. The hypothesis about the regional type expected to have the highest unmet healthcare need was not proved. The hypothesis about the lowest expected regional type was proved, but the difference in the average rate of unmet healthcare needs among regional types was not significant. The standard deviation of the rate of unmet healthcare needs among regions within the same type was also higher than the overall regional variation, which also disproved the whole frame of hypothesis. Conclusion: Failure to prove the hypothesis means the gap between the supposed meaning of the indicator and the reality. In order to understand the current state of healthcare utilization of people in various regions of Korea and to resolve inequality, fundamental research on the in-depth structure and mechanisms of healthcare utilization is needed.

• Health Policy and Management
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• v.29 no.2
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• pp.184-194
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• 2019

Background: The extent of coverage rate of the public health insurance is still insufficient to meet healthcare needs. Private health insurance (PHI) plays a role to supplement coverage level of national health insurance in Korea. It is expected that reduce unmet need healthcare. This study was aimed to identify relationship between PHI type and the unmet healthcare need and its associated factors. Methods: Data were obtained from the 2014 Korea Health Panel Survey using nationally representative sample was analyzed. Respondents were 8,667 who were adults over 20 years covered by PHI but have not changed their contract. According to the enrollment form, PHI was classified into three types: fixed-benefit, indemnity, and mixed-type. To identify factors associated with unmet needs, multiple logistic regression conducted using the Andersen model factors, which are predisposing factors, enabling factors, and need factors. Results: Our analysis found that subjects who had PHI with mixed-type were less likely to experience unmet health care needs compared than those who did not have it (odds ratio, 0.80; 95% confidence interval, 0.66-0.98). As a result of analyzing what affected their unmet healthcare needs, the significant factors associated with unmet medical need were gender, marital status, residence in a metropolitan area, low household income, economic activity participation, self-employed insured, physically disabled, low subjective health status, and health-risk factors such as current smoking and drinking. Conclusion: The results of this study suggest that having PHI may reduce experience of unmet healthcare needs. Findings unmet healthcare needs factors according to various subjects may be useful in consideration of setting policies for improving accessibility to healthcare in Korea.