• Journal of Korean Academy of Nursing
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• v.39 no.4
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• pp.480-489
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• 2009

Purpose: The purpose of this study was to identify the factors which influence health-related quality of life (HRQoL) in Korean Medicaid beneficiaries. The relationships among sociodemographic factors, health status, health behavior, and HRQoL were analyzed. Methods: Data from the 2007 survey on Health Services Use and Health Status of Medicaid Beneficiaries conducted by the Ministry for Health Welfare and Family Affairs were examined. To analyze the sample survey data, descriptive statistics, correlation and hierarchical multiple survey regression analysis with SAS 9.1.3 package were used with SURVEYMEANS and SURVEYREG procedures, which incorporate the sample design into the analyses in order to make statistically valid inference for the whole Medicaid population. Results: The HRQoL correlated with limitations in Activities of Daily Living (ADL) (r=-.509, p<.001), stress (r=-.387, p<.001), depression (r=-.385, p<.001), alcohol consumption (r=.216, p<.001), and exercise (r=.293, p<.001). Significant factors that affect HRQoL of Medicaid beneficiaries were gender, region, limitations in ADL, stress, depression, alcohol consumption, and regular exercise. These variables explained 44.6% of HRQoL (F= 215.00, p<.001). Conclusion: The results indicate that to improve the HRQoL of Medicaid beneficiaries it is important to develop nursing intervention programs that focus on psychological health and health behavior and to give consideration to differences in gender and region.

• Journal of Korean Public Health Nursing
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• v.26 no.2
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• pp.289-302
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• 2012

Purpose: The purpose of this study was to compare the effectiveness of case management in elderly medicaid beneficiaries according to geographic location. Methods: Data were collected from 23,633 elderly medicaid beneficiaries assigned from over users of medicaid. We used the need assessment tool developed by the government, which consists of 19 items with four subscales. Results: Among elderly medicaid beneficiaries, statistically significant differences in effectiveness of case management were observed for quality of life, self-care competency, medical care utility, and support system. Differences in case management effectiveness were higher in urban areas than in metropolitan or rural areas. Conclusion: The differentiated and tailored intervention model based on characteristics of participants, resource distribution, and geographic location may be needed for effective case management for elderly medicaid beneficiaries.

• Research in Community and Public Health Nursing
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• v.23 no.4
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• pp.438-445
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• 2012

Purpose: Medical Aid Beneficiaries were surveyed to identify differences in health behaviors, adherence to drug regimen, and quality of life between those people in the Designated Doctor System and those who are not. Methods: A total of 1,327 study subjects were separated into three groups: those in the Designated Doctor System for 2 years, those in for 1 year, and those not in the system. Results: After the introduction of the Designated Doctor System, 55.8% and 67.9%, respectively, of the subjects in the Designated Doctor System complained of inconvenience in relation to hospital use and the patient referral process. Also, the rate of emergency room use or hospitalization guided by the Designated Doctor System was only 8.7% and 6.5%, respectively. There were no significant differences in health behaviors and adherence to drug regimens between those in the Designated Doctor System and those who are not. Conclusion: This study was carried out early in the introduction of the system. Therefore, it is necessary to monitor the positive and negative effects of the Designated Doctor System for a full reflection of its impact.

• Health Policy and Management
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• v.20 no.1
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• pp.87-102
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• 2010

The objective of this study were to examine the impact of medicaid coverage expansion policy aimed at improving access to primary care. The case-control study was conducted to compare preventable hospitalization(PH) rate in new medicaid recipients versus national health insurance(NHI) enrollees form 1996 to 2001. Rates of preventable hospitalization associated with ambulatory care sensitive conditions(ACSC) were calculated and standardized by age and sex. Multinomial logit regression model was used to control the confounding factors such as age, gender and charlson comorbidity index Annual PH rates in the new medicaid increased 1.64 times after medicaid expansion, with controling confounding factors. Meanwhile, annual PH rate in the NHI increased 1.68 times during the same period, with adjusting confounding factors. Current findings suggest that the new medicaid PH rate was less likely to rise than NHI PH rate after implementing medicaid expansion. This study is expected to provide policy-relevant evidence of medicaid expansion to include population with low income.

• Journal of Preventive Medicine and Public Health
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• v.43 no.1
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• pp.35-41
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• 2010

Objectives: In Korea, the top 10% of Medical Aid recipients represent nearly 60% of total payment, with the costs for those disabled for over 365 days representing approximately 30% of total payment. The purpose of this study was to compare Medical Aid use of the disabled with non-disabled recipients, and to identify contributing factors to the total payment in the top 2% of recipients identified as Medical Aid overusers. Methods: Subjects (n=2,211) selected were ${\geq}18$-years-of-age and received >1000 days of co-payment-free type I Medical Aid. Case managers (n=200) conducted interviews in December 2006, and collected data from Health Insurance Review & Assessment Service. Amounts over the 9 months from January September 2006 were analyzed descriptively and using Chi-square, ANCOVA, and robust multiple linear regression. Results: Disabled individuals (mean age 61.3 years) composed 36.6% of subjects; 44.8% of the disabled were male. On a monthly basis per capita, the disabled group averaged 10.5 outpatient days, total payment of 523,000 Korean Won(￦), inpatient payment of ￦359,000, and outpatient payment of ￦183,000. All values exceeded the monthly average for non-disabled individuals. Contributing factors were identified as male gender (￦82,000), elementary school or lower educational level (￦64,000), residence in a small city (￦82,000), lack of family support (￦61,000), kidney disability (￦673,000), intellectual disability (￦151,000), and multiple disabilities (￦119,000). Conclusions: The identification of contributing factors to Medical Aid use by those defined as disabled supports the adoption of comprehensive alternative policies such as strengthening of education and consultation services, provision of alternative facilities, and promotion of self-care.

• Journal of agricultural medicine and community health
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• v.34 no.2
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• pp.256-266
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• 2009

Objectives: This study was to investigate the factors affecting the depression of the elderly women in poverty in community. Methods: The subjects were 1,208 elderly women over 65 years who were enrolled in the Public Health Care Center from Apr. 2008 to Jun. 2008. Data were collected using questionnaires including general characteristics, health related behaviors and health status by nurses at the time of enrollment. The collected data were analyzed by descriptive statistics, $x^2$-test, Pearson correlation coefficients and multivariate logistic regression. Results: The major findings of this study are as follows : The elderly women in poverty show a tendency to have lower level in income, education, self-rated health, cognitive function compared with ordinary women in old age. The predictors of depression of the elderly women in poverty were spouse's existence or nonexistence, type of insurance, cognitive function, and self-rated health. Conclusion: These findings suggest the need to develop nursing strategies for decreasing depression in the elderly women in poverty. To decrease the depression of the elderly women, the above-mentioned major influencing factors should be considered.

• Journal of Preventive Medicine and Public Health
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• v.42 no.6
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• pp.403-407
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• 2009

Objectives : The amount of medical utilization by Medical Aid recipients was 3.7 times that of patients with Korean Medical Insurance. This study aims to describe the surplus medicine and the medication-related utilization, and to determine factors contributing to surplus medicine. Methods : Among those who used copayment-free Class I Medical Aid in 2005, 146,880 subjects who were $\geq19$ year-old and received >365 days medical treatment per year were studied with their case managers by conducting face-to-face interviews. The analytic methods were description, chi-square, t-tests, ANCOVA and multiple logistic regressions. Results : Most subjects were female (68.6%), the elderly (62.5%), and the separated (61.6%), had an elementary graduation or less (74.8%), and had disabilities (33.2%). The percentage of subjects with surplus medicine was 18.5%. However, the percentage of females, the elderly, those with non-disabilities, the separated, the uneducated, those with a very poor perceived health status and those with an economical burden for medical treatment was 19.3%, 18.9%, 19.0%, 19.3%, 19.0%, 20.2% and 24.3%, respectively. For subjects with surplus medicine, averages for the number of used pharmacies, the pharmacy-visit days and the medication costs were 4.6 drugstores, 34.9 days and approximately 1,124 thousand Won(￦). These values were higher than those without surplus medicine (4.4 drugstores, 33.8 days, and ￦1,110 thousand, respectively). The odds ratios of the contributing factors to surplus medicine were female 1.11 (95% CI=1.07-1.14), the elderly 1.06 (95% CI=1.02-1.10), those with non-disabilities 1.08 (95% CI=1.05-1.12), the separated 1.14 (95% CI=1.10-1.18), the unmarried 1.12 (95% CI=1.07-1.18), the uneducated 1.03 (95% CI=1.01-1.08), those with a very poor perceived health status 1.04 (95% CI=1.01-1.08) and experiencing an economical burden for medical treatment 2.33 (95% CI=2.26-2.40). Conclusions : 18.5% of subjects had surplus medicine with a higher mean of medication cost. Therefore, health education and health promotion programs to prevent surplus medicine and to improve the appropriate usage of medication are necessary.

• Journal of the Korean Society of Food Science and Nutrition
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• v.43 no.1
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• pp.141-150
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• 2014

This study was carried out to investigate the effects of nutrition education on blood glucose in type 2 diabetic patients with low income. There were 50 (27 male and 23 female) study subjects with type 2 diabetes under national medical support, and the monthly income in most of them was less than 500,000 won. Anthropometric measurement, biochemical blood indices, food intake, dietary habits, and nutrition knowledge of the subjects were investigated before nutrition education. Nutrition education was conducted 6 times within 12 weeks. After nutrition education, the glycosylated hemoglobin was significantly decreased (male: $8.4{\pm}1.6%$ to $8.0{\pm}1.7%$, female: $8.3{\pm}1.6%$ to $8.0{\pm}1.3%$) and the total cholesterol was also significantly decreased in both groups. The group of female resulted in a significant decrease in fasting blood glucose ($169.7{\pm}28.2$ mg/dL to $152.8{\pm}22.0$ mg/dL) and triglyceride ($177.8{\pm}56.3$ mg/dL to $162.3{\pm}36.1$ mg/dL), but the group of male did not show a significant decrease in fasting blood glucose and triglyceride. Nutritional knowledge and dietary habit scores of the subjects were significantly improved after nutrition education. The results demonstrate that nutrition education for type 2 diabetic patients with low income are effective in improving their blood glucose.