• International Journal of Contents
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• v.13 no.2
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• pp.14-20
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• 2017

The purpose of this study was to investigate the association of obesity with medical care use and costs according to overall diseases, cerebrovascular diseases (CVD), ischemic heart disease (IHD), hypertension (HTN) and diabetes mellitus (DM). The final sample was a group of persons who were free of diseases mentioned above and were not underweight. Their baseline screening program data and health insurance contribution data were connected with a 7-year medical claim database. The participants were classified according to their baseline BMI into normal, overweight, obese, and severely obese groups. Given the disease type, the total costs of DM showed the largest difference in each obesity group in both males and females. Also, the pharmacy costs for DM were more relevant than any other type of service to the obesity level. Considering the high prevalence of obesity and the relevantly increased medical care use and costs, there is a need for reduction in medical costs through obesity prevention efforts.

• Journal of Preventive Medicine and Public Health
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• v.50 no.5
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• pp.303-310
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• 2017

Objectives: The aim of this study was to evaluate socioeconomic inequalities in the prevalence of dental caries among an urban population. Methods: This study was conducted among 2000 people 15-40 years of age living in Kurdistan, Iran in 2015. Using a questionnaire, data were collected by 4 trained dental students. The dependent variable was the decayed, missing, and filled teeth (DMF) index. Using principal component analysis, the socioeconomic status (SES) of families was determined based on their household assets. Inequality was measured using the concentration index; in addition, the Oaxaca analytical method was used to determine the contribution of various determinants to the observed inequality. Results: The concentration index for poor scores on the DMF index was -0.32 (95% confidence interval [CI], -0.40 to -0.36); thus, poor DMF indices had a greater concentration in groups with a low SES (p<0.001). Decomposition analysis showed that the mean prevalence of a poor DMF index was 43.7% (95% CI, 40.4 to 46.9%) in the least privileged group and 14.4% (95% CI, 9.5 to 9.2%) in the most privileged group. It was found that 85.8% of the gap observed between these groups was due to differences in sex, parents' education, and the district of residence. A poor DMF index was less prevalent among people with higher SES than among those with lower SES (odds ratio, 0.31; 95% CI, 0.19 to 0.52). Conclusions: An alarming degree of SES inequality in oral health status was found in the studied community. Hence, it is suggested that inequalities in oral health status be reduced via adopting appropriate policies such as the delivery of oral health services to poorer groups and covering such services in insurance programs.

• Korean Journal of Psychosomatic Medicine
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• v.24 no.1
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• pp.74-82
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• 2016

Objectives : Suicide attempters have impaired decision making and are at high risk of reattempt. Therefore it is important to refer them to psychiatric treatment. Especially, People with medical comorbidity are at higher risk of suicidal attempt and mortality. The aim of this study was to investigate the characteristics of suicidal attempters and to analyze the influence of the medical comorbidity on decision to receive psychiatric treatment after visit to an emergency department. Methods : One hundred and thirty two patients, who visited the emergency room of a general hospital in Gyeonggi-do between January, 2012 and December, 2012 were enrolled as the subjects of this study. After reviewing each subject's medical records retrospectively, demographic and clinical factors were analyzed. Results : Regardless of the engagement type, either via admission or outpatient clinic, the determinant factors of psychiatric treatment engagement were psychiatric diagnosis, employment status, previous psychiatric treatment history, and previous attempt history. Comparison of severity of medical comorbidity(Charlson Comorbidity Index) showed that suicide attempters who received psychiatric treatment via admission or refused the treatment tended to have higher level of medical comorbidity than who received psychiatric treatment via outpatient department. Conclusions : Our findings showed that medical comorbidity of suicide attempters affected the decision to accept psychiatric treatment. All psychiatrists should evaluate the presence and the severity of medical comorbidity of the suicide attempters and consider implementing more intervention for the medically ill attempters who are willing to discharge against advice.

• Health Policy and Management
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• v.11 no.3
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• pp.46-70
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• 2001

Medical Aid expenditure Increased rapidly at a higher rate than that of Medical Insurance during the period 1992-1999. To establish an effective cost containment strategy, knowledge of the cause and the nature of the increase of Medical Aid expenditure is required. The purpose of this study was to analyze increasing rates of Medical Aid expenditure by the components of medical expenses. Data were collected using the Medical Aid Statistical Yearbook during the period of 1992-1999. The major findings were as follows: 1. The annual mean increasing rate of Medical Aid expenditure between 1992 and 1999 was 22.8%, which exceeding that of Medical Insurance expenditure (17.5%) between 1992 and 1999. Since 1998, Medical Aid expenditure increased even more rapidly than in previous years, with the increase in number of Medical Aid beneficiaries. 2. Of Medical Aid expenditure, that of inpatient and outpatient annually increased 24.2% and 22.8% respectively and that of type 1 and type 2 increased annually 28.8% (outpatient) ∼29.9% (inpatient), 14.3% (outpatient) ∼ 15.5% (inpatient). Therefore, Medical Aid expenditure of inpatient and type 1 led the increase of Medical Aid expenditure. 3. Between 1992 and 1997, the frequencies of utilization per beneficiary and the charges per case positively contributed to the increase of Medical Aid expenditure while the number of beneficiaries contributed negatively, but since 1998, the number of beneficiaries increased and positively contributed to the increase of Medical Aid expenditure. 4. According to the analysis of the charges per case, the increase of the price index led to the increase of the charges per case but the days of medication and service intensity also contributed to the increase of the charges per case variably by year. Considering the above findings, factors associated with the Medical Aid system affected the increase of Medical Aid expenditure in addition to the general factors of the increase in medical expenditure. In conclusion, it appears that a more intensive cost containment strategy is required to control rapidly increasing Medical Aid expenditure. For this, more precise analysis and development of policy considering the effect of the number of beneficiaries and the increase of price index is needed.

• Journal of Preventive Medicine and Public Health
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• v.46 no.6
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• pp.300-308
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• 2013

Objectives: The purpose of this study was to classify determinants of cost increases into two categories, negotiable factors and non-negotiable factors, in order to identify the determinants of health care expenditure increases and to clarify the contribution of associated factors selected based on a literature review. Methods: The data in this analysis was from the statistical yearbooks of National Health Insurance Service, the Economic Index from Statistics Korea and regional statistical yearbooks. The unit of analysis was the annual growth rate of variables of 16 cities and provinces from 2003 to 2010. First, multiple regression was used to identify the determinants of health care expenditures. We then used hierarchical multiple regression to calculate the contribution of associated factors. The changes of coefficients ($R^2$) of predictors, which were entered into this analysis step by step based on the empirical evidence of the investigator could explain the contribution of predictors to increased medical cost. Results: Health spending was mainly associated with the proportion of the elderly population, but the Medicare Economic Index (MEI) showed an inverse association. The contribution of predictors was as follows: the proportion of elderly in the population (22.4%), gross domestic product (GDP) per capita (4.5%), MEI (-12%), and other predictors (less than 1%). Conclusions: As Baby Boomers enter retirement, an increasing proportion of the population aged 65 and over and the GDP will continue to increase, thus accelerating the inflation of health care expenditures and precipitating a crisis in the health insurance system. Policy makers should consider providing comprehensive health services by an accountable care organization to achieve cost savings while ensuring high-quality care.

• Health Policy and Management
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• v.30 no.3
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• pp.418-429
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• 2020

Background: This study aims to analyze the cost and the length of stay (LOS) of acute myocardial infarction (AMI) patients with coronary artery stenting according to the characteristics of individuals and institutions. Methods: The data was collected from Korean National Health Insurance Service's customized database in 2010 and 2015. Chi-square test, t-test, analysis of variance, and multilevel analysis were performed. Results: The intraclass correlation coefficients for cost were 7.02% in 2010, 5.61% in 2015 and for LOS were 3.17%, 1.40%, respectively. The average costs were 9,067,000 won in 2010 and 9,889,000 won in 2015 (p<0.0001). However, the cost in 2015 was lower than the cost applying increased fee. The costs increased in aged 50-59 years, 60-69 years, and aged ≥70 years versus in aged under 49 years. The cost was higher in Charlson comorbidity index (CCI) 3 to 4 and ≥5 than in CCI 0. The costs were lower in male, medical aid recipients, metropolises, and local hospitals in other regions in 2010. LOS decreased from 8.1 days in 2010 to 7.4 days in 2015. It decreased in male, high income group, and the group of admission via emergency room. However, it increased in higher ages and medical aid recipients, and it also increased when CCI rose. The Internal Herfindahl Index was related to LOS in 2010. Conclusion: The variation of hospital level was small compared to the patient level. Therefore, it is important to implement applicable policies at the patient level in order to reduce cost and LOS of AMI patients.

• Physical Therapy Korea
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• v.17 no.4
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• pp.61-68
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• 2010

The purpose of this study was to investigate the effects of a workplace-based work-conditioning program (WCP) on the management of work-related musculoskeletal disorders (WRMDs) in an automobile-parts manufacturing company. In total, 1,110 subjects with WRMDs participated in workplace-based WCP emphasizing function-centered management and ergonomics. We investigated the incidence of WRMDs variables (number of persons diagnosed with industrial accident-related WHMDs, number of cases of WRMD) and financial benefits (cost of workers' compensation insurance and lost work days related to WRMDs) per year before and after WCP. Additionally, we compared self-reported pain intensity and functional disability in subjects with musculoskeletal pain before and after the WCP. Pain intensity was measured using a visual analog scale (VAS), and functional disability was measured by the neck disability index (NDI) and the Oswestry disability Index (ODI). The number of person diagnosed with industrial accident-related WRMDs, the number of cases of WRMD, the cost of workers' compensation insurance and lost work days related to WRMDs per year decreased by 51%, 37%, 34%, and 47%, respectively, and VAS, NDI, and ODI scores decreased significantly after implementation of WCP (p<.05). Thus, the results of the present study suggest that function-centered, workplace-based WCP was effective in managing WRMDs at an automobile-parts manufacturing company.

• Progress in Medical Physics
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• v.28 no.2
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• pp.54-60
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• 2017

This study was designed to measure transit dose with an electronic portal imaging device (EPID) in eight patients treated with intensity modulated radiotherapy (IMRT), and to verify the accuracy of dose delivery to patients. The calculated dose map of the treatment planning system (TPS) was compared with the EPID based dose measured on the same plane with a gamma index method. The plan for each patient was verified prior to treatment with a diode array (MapCHECK) and portal dose image prediction (PDIP). To simulate possible patient positioning errors during treatment, outcomes were evaluated after an anthropomorphic phantom was displaced 5 and 10 mm in various directions. Based on 3%/3 mm criteria, the $mean{\pm}SD$ passing rates of MapCHECK, PDIP (pre-treatment QA) for 47 IMRT were $99.8{\pm}0.1%$, $99.0{\pm}0.7%$, and, respectively. Besides, passing rates using transit dosimetry was $90.0{\pm}1.5%$ for the same condition. Setup errors of 5 and 10 mm reduced the mean passing rates by 1.3% and 3.0% (inferior to superior), 2.2% and 4.3% (superior to inferior), 5.9% and 10.9% (left to right), and 8.9% and 16.3% (right to left), respectively. These findings suggest that the transit dose-based IMRT verification method using EPID, in which the transit dose from patients is compared with the dose map calculated from the TPS, may be useful in verifying various errors including setup and/or patient positioning error, inhomogeneity and target motions.

• The Journal of the Korea Contents Association
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• v.17 no.9
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• pp.476-485
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• 2017

This study was analyzed obesity status by divided into six classification based on the body mass index(BMI) established by World Health Organization-Western Pacific Regional Office(WHO-WPRO) through National Health Insurance Service(NHIS). In the middle of process, problems of outlier solved by presenting the median repeated interpolation. Unlike linear and Lagrange interpolation, median repeated interpolation may be useful in multiple outlier contained dataset. As a result, we found that extreme low and obesity weight gradually increased and the frequency of normal body weight gradually decreased. Especially, the increase of obesity in men and women of lower age group is increasing. Overall, this study suggests that national measures need to be taken before health problems arising from obesity can spread to other social problems.

• The Journal of the Korean life insurance medical association
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• v.4 no.1
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• pp.44-76
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• 1987

Present study was undertaken to establish the modified Broca's indices to estimate standard body weight by using a total of 5,496 insured persons who were medically examined at the Honam Medical Room of Dong Bang Life Insurance Company Ltd. from January, 1983 to January, 1986. The results were as follows: 1. The linear regression equations of body weight to $height^3$ to estimate standard body weight were as follows: In male, for $18{\sim}19$ age group $y=7.272{\times}10^{-6}{\times}x^3+23.560$ for $20{\sim}29$ age group $y=8.187{\times}10^{-6}{\times}x^3+22.031$ for $30{\sim}39$ age group $y=8.627{\times}10^{-6}{\times}x^3+23.169$ for $40{\sim}49$ age group $y=9.561{\times}10^{-6}{\times}x^3+20.994$ for $50{\sim}59$ age group $y=8.604{\times}10^{-6}{\times}x^3+23.081$ and for all ages group $y=7.778{\times}10^{-6}{\times}x^3+25.929$ In female, for $18{\sim}19$ age group $y=8.252{\times}10^{-6}{\times}x^3+18.920$ for $20{\sim}29$ age group $y=7.715{\times}10^{-6}{\times}x^3+22.409$ for $30{\sim}39$ age group $y=8.808{\times}10^{-6}{\times}x^3+21.440$ for $40{\sim}49$ age group $y=9.691{\times}10^{-6}{\times}x^3+21.940$ for $50{\sim}59$ age group $y=12.550{\times}10^{-6}{\times}x^3+11.031$ and for all ages group $y=7.300{\times}10^{-6}{\times}x^3+26.601$ In both sexes, for all ages group $y=8.342{\times}10^{-6}{\times}x^3+22.998$ 2. The modified Broca's index is expressed by formula $\{height(cm)-100\}{\times}K(kg)$. K is obtained from the following formula standard weight to average height estimated $\frac{by\;means\;of\;linear\;regression\;equation(kg)}{\{Average\;height(cm)-100\}{\times}K(kg)}$=1 Author's modified Broca's indices are as follows: In male, for $18{\sim}19$ age group $\{height(cm)-100\}{\times}0.85(kg)$ for $20{\sim}29$ age group $\{height(cm)-100\}{\times}0.90(kg)$ for $30{\sim}39$ age group $\{height(cm)-100\}{\times}0.95(kg)$ for $40{\sim}49$ age group $\{height(cm)-100\}{\times}1.00(kg)$ for $50{\sim}59$ age group $\{height(cm)-100\}{\times}0.95(kg)$ and for all ages group $\{height(cm)-100\}{\times}0.95(kg)$ In female, for $18{\sim}19$ age group $\{height(cm)-100\}{\times}0.90(kg)$ for $20{\sim}29$ age group $\{height(cm)-100\}{\times}0.90(kg)$ for $30{\sim}39$ age group $\{height(cm)-100\}{\times}1.00(kg)$ for $40{\sim}49$ age group $\{height(cm)-100\}{\times}1.05(kg)$ for $50{\sim}59$ age group $\{height(cm)-100\}{\times}1.05(kg)$ and for all ages group $\{height(cm)-100\}{\times}1.00(kg)$ In both sexes, for all age group $\{height(cm)-100\}{\times}0.95(kg)$ 3. Several types of modified Broca's index recommended by author are as follows: I. In male, for $18{\sim}29$ age group $\{height(cm)-100\}{\times}0.90(kg)$ and for $30{\sim}59$ age group $\{height(cm)-100\}{\times}0.95(kg)$ In female, for $18{\sim}29$ age group $\{height(cm)-100\}{\times}0.90(kg)$ and for $30{\sim}39$ age group $\{height(cm)-100\}{\times}1.00(kg)$ II. In male, for all ages group $\{height(cm)-100\}{\times}0.95(kg)$ In female, for all ages group $\{height(cm)-100\}{\times}1.00(kg)$ III. In both sexes, for all ages group $\{height(cm)-100\}{\times}0.95(kg)$ Note: The first type of modified Broca's index is the most precise one in estimating standard body weight among several types established by author. 4. Error of estimated standard body weight appearing by applying modified Broca's indices is generally greater in short build persons than in tall build persons and is more dominant especially in female group.