• Radiation Oncology Journal
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• v.34 no.2
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• pp.88-95
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• 2016

Purpose: The purpose of this study was to estimate the clinical utilization of radiation therapy (RT) in Korea between 2009 and 2013. Materials and Methods: We analyzed open claims data from the Health Insurance Review and Assessment Service. The subjects were patients who had diagnostic codes C00-C97 or D00-D48 according to the 10th revision of the International Classification of Diseases, with procedure codes indicating RT treatment. Results: The total number of patients who received RT in 2009, 2010, 2011, 2012, and 2013 were 45,571, 49,593, 54,671, 59,172, and 61,485, respectively. Among them, the total numbers of male and female patients were 20,780/24,791 in 2009, 22,711/26,882 in 2010, 24,872/29,799 in 2011, 27,101/32,071 in 2012, and 27,941/33,544 in 2013. The five cancers that were most frequently treated with RT between 2009 and 2012 were breast, lung, colorectal, liver, and uterine cervical cancers. However, the fifth most common cancer treated with RT that replaced uterine cervical cancer in 2013 was prostate cancer. The three leading types of cancer among the male patients were lung, colorectal, and liver cancers, whereas in female patients, they were breast, uterine cervical, and lung cancers. The type of cancer most commonly treated by RT was cancer of the central nervous system in patients aged 20 years or less, breast cancer in patients aged 30-50 years, and lung cancer in patients aged 60 years or more. Conclusion: Data from this study provided the clinical utilization of RT in Korea between 2009 and 2013.

• Journal of Preventive Medicine and Public Health
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• v.34 no.4
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• pp.337-346
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• 2001

Objective : To determine the clinical risk factors associated with the mode of delivery decision and to compare cesarean section rates after adjusting for risk factors identified among Korean hospitals. Methods Data were collected from 9 general hospitals in two provincial regions by medical record abstraction during February 2000. A total of 3,467 cases were enrolled and analyzed by stepwise logistic regression. Performance of the risk-adjustment model (discrimination and calibration) was evaluated by the C statistic and the Hosmer-Lemeshow test. Crude rates, predicted rates with 95% confidence intervals, and adjusted rates of cesarean section were calculated and compared among the hospitals. Results : The average crude cesarean section rate was 53.2%, ranging from 39.4% to 65.7%. Several risk factors such as maternal age, previous history of cesarean section, placenta previa, placental abruption, malpresentation, amniotic fluid abnormality, gestational anemia, infant body weight, pregnancy-induced hypertension, and chorioamnionitis were found to have statistically significant effects on the mode of delivery. It was confirmed that information about most of these risk factors was able to be collected through the national health insurance claims database in Korea. Performance of the risk-adjustment model was good (c statistic=0.815, Hosmer-Lemeshow test=0.0621). Risk factor adjustment did lead to some change in the rank of hospital cesarean section rates. The crude rates of three hospitals were beyond 95% confidence intervals of the predicted rates. Conclusions : Considering that cesarean section rates in Korean hospitals are too high, it is apparent that some policy interventions need to be introduced. The concept and methodology of risk adjustment should be used in the process of health policy development to lower the cesarean section rate in Korea.

• 한국사회정책
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• v.25 no.1
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• pp.45-70
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• 2018

After critically assessing the effectiveness of basic income as an alternative to the existing social security system, this article argues that basic income is fundamentally incapable of providing an adequate protection for those in social risks or welfare needs. The proponents of basic income often claims that technological innovations will lead to the end of work and thus that basic income will be required for all citizens in the future. Moreover, they emphasize that labor market flexibility is making a large segment of work forces unstable working poor, what is often called the precariat who are not effectively protected by the existing social insurance programs. For them, basic income is the best source of social protection for the precariat of today and the citizens in the future, freeing them from the necessity of having a paid work. This article, however, points out the ineffectiveness of basic income as social protection due to its unustainably high cost that comes from unconditional benefit provisions regardless of levels of income, social risks, and welfare needs. Also it challenges the simplified 'Luddites' image of workless society in the future, arguning that techological unemployment can be overcome by new job creation as seen in Silicon Valley and job sharing following working time reduction. It maintains that it is more cost-effective and reliable to strengthen the welfare state based on the principle of reciprocity that aims at 'universal sufficient protection for those in social risks and welfare needs.'

• Journal of Gynecologic Oncology
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• v.29 no.6
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• pp.83.1-83.10
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• 2018

Objective: We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan. Methods: A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected. Results: In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for 'cystoscope or proctoscope for stage IVA' to 98.8% for 'chemotherapy using platinum for stage IVB'. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively. Conclusion: Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.

• Journal of Chest Surgery
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• v.55 no.5
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• pp.378-387
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• 2022

Background: Atrial fibrillation (Afib) is a marker of increased cardiovascular morbidity and mortality. Owing to the increased prevalence of Afib in patients undergoing cardiac surgery, assessing the effect of Afib on postsurgical outcomes is important. We aimed to analyze the effect of preoperative Afib on clinical outcomes in patients undergoing cardiac surgery using a large surgical database. Methods: This retrospective cohort study was based on the national health claims database established by the National Health Insurance Service of the Republic of Korea from 2009 to 2015. Diagnosis and procedure codes were used to identify diseases according to the International Statistical Classification of Diseases, 10th revision. Results: We included 1,037 patients (0.1%) who had undergone cardiac surgery from a randomized 1,000,000-patient cohort, and 15 patients (1.5%) treated with isolated surgical Afib ablation were excluded. Of these 1,022 patients, 412 (39.7%), 303 (29.2%), and 92 (9.0%) underwent coronary artery bypass, heart valve surgery, and Cox-maze surgery, respectively. Preoperative Afib was associated with higher patient mortality (p=0.028), regardless of the surgical procedure. Patients with preoperative Afib (n=190, 18.6%) experienced a higher cumulative risk of overall mortality (hazard ratio [HR], 1.435; 95% confidence interval [CI], 1.263-2.107; p=0.034). Subgroup analysis revealed a reduced risk of overall mortality with Cox-maze surgery in Afib patients (HR, 0.500; 95% CI, 0.266-0.938; p=0.031). Postoperative cerebral ischemia or hemorrhage events were not related to Afib. Conclusion: Preoperative Afib was independently associated with worse long-term postoperative outcomes after cardiac surgery. Concomitant Cox-maze surgery may improve the survival rate.

• Pediatric Infection and Vaccine
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• v.28 no.3
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• pp.144-148
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• 2021

Purpose: Nonpharmaceutical measures, such as social distancing, have resulted in unintended consequences, including a decrease in the incidence of childhood diseases. This study aimed to estimate the impact of social distancing on the incidence of febrile seizure (FS) in Korea using nationally representative data. Methods: We used claims data from the Health Insurance Review and Assessment Service, a single-payer database capturing >95% of the Korean population. The database included any inpatient encounter with a FS diagnosis from January 2010 to September 2020 for those aged 0-5 years old. We aggregated the monthly number of cases to estimate the incidence per 100,000 patient-years in 2020 (January 1 to September 30) for the same periods in 2010-2019. Results: The incidence of FS in 2020 ranged from 113 per 100,000 (95% confidence interval [CI], 108-118 per 100,000) in January to 27 per 100,000 (95% CI, 25-30 per 100,000) in September, whereas the average FS incidence in 2010-2019 ranged from 116 per 100,000 (95% CI, 112-121 per 100,000) in January to 101 per 100,000 (95% CI, 97-106 per 100,000) in September. Conclusions: The incidence of FS decreased by -38% in 2020, suggesting that social distancing contributed towards decreasing the incidence of FS.

• Health Policy and Management
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• v.4 no.1
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• pp.49-76
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• 1994

Small area variations in health care utilization have long been studied as an important issue related to boto cost containment and quality assurance. This study was conducted to investigate if variations in hospital services across small geographic areas in Korea existed. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows : 1. Extremal Quotients(EQ) of hospital expenditure per capita and hospital days per capita varied among diagnosis types. The EQ ranged from 2.05(cataract) to 41.67(pneumonia) in hospital expenditure per capita and from 1.86(cataract) to 45.89(pneumonia) in hospital days per capita. The diagnosis groups which showed high variation were pneumonia, cephalo-pelvic disproportion, gastritis and duodenitis, fracture of rib, and acute bronchitis. Those which showed low variation were acute appendicitis and cataract. 2. The EQ level of admission rate was different in terms of diagnosis types, ranging from 2.57(catarct) to 44.45(pneumonia). The variations were high in medical disorders such as pneumonia, oephalo-pelvic disproportion, gastritis and duodenitis and acute bronchitis, while relatively low in surgical conditions such as acute appendicitis and cataract. 3. As an indicator of service intensity, the EQ of expenditure per admission ranged from 1.67(acute appendicitis) to 31.27(essential hypertension). The diagnoses which had high variation were essential hypertension, gastric ulcer, whereas those which had low variation were cephalopelvic disproportion and acute appendicitis. With regard to hospital days per admission, the EQ ranged from 1.55(acute appendicitis) to 28.13(gastric ulcer) by diagnosis types. The diagnosis groups with showed high variation were gastric ulcer, essential hypertension, and acute bronchitis, whereas those with low variation were cephalo-pelvic disproportion, intervertebral disc disorders, and acute appendicitis. Both the expenditure and hospital days per admission showed lewwer variations than the expenditure per capita, hospital days per capita and admission rate. 4. Comparing patterns of variation in utilization indices, diagnoses such as essential hypertension, gastric ulcer, fracture of rib showed higher variations in expenditure per admission than in admission rates, whereas diagnoses such as pneumonia, cephalo-pelvic disproportion and gastric ulcer showed higher variations in admission rate than expenditure per admission. These findings suggest that wide variations existed in several diagnoses groups across small areas in Korea. Further research should be performed to investigate factors related to small area variations including provider behavior.

• Journal of Korean Dental Hygiene Science
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• v.2 no.1
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• pp.41-50
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• 2019

Education should consider the social consensus that changes according to the times and the social environment, and it is also necessary to consider the technically useful subjects. We collected and reported the 4-year course curriculum of dental hygiene when Korean dental hygiene education has continued over 50 years. Each 4-year course curriculum was collected by searching each university website, or requested by email. The curriculum of 23 among 27 schools was collected. According to the classification of dental hygiene in the dental hygienist national examination classification or the Korean society of dental hygiene science, the subjects of the course were divided into clinical dental hygiene, clinical dental treatment support, basic dental hygiene, social and educational dental hygiene, and collected 23 curriculum courses. The average major curriculum was 104.9 credits and the average number of subjects in major courses was 34.3. The average subjects' number of clinical dental hygienic courses was 33.9 (37.5% of the total major credits), clinical dental treatment support was 30.6 (30.2% of the total major credits), basic dental hygiene was 21.8 (20.8% of the total major credits), and social and educational dental hygiene courses was 13.6 (13.0% of total major credits). Integrated subjects' name in clinical dental hygiene was used in all schools of the survey, such as clinical dental hygiene education (and practice), comprehensive dental hygiene education, and integrated dental hygiene. There were 13 schools (56.5%) that use the integrated name in clinical dental treatment support, such as clinical dentistry. There were 14 schools (60.9%) to open dental clinic management, and 22 schools (95.7%) to open national health insurance claims. The basic dental hygiene curriculum maintained the title of each subject and social and educational dental hygiene education was established in most schools, such as community dental health, oral health statistics, and oral health education. Other subjects were English conversation in dental clinic (8 schools) education, clinical dental treatment support, basic science in dental hygiene, social and educational dental hygiene. We knew the clinical dental hygiene and clinical dental treatment support were changing into the integrated subjects, and most schools run dental hygiene research.

• Journal of the korean academy of Pediatric Dentistry
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• v.50 no.3
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• pp.360-372
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• 2023

The aim of this study was to identify the current state of pediatric dentists, evaluate the adequacy of pediatric dentist supply and demand, and find out the perception of all pediatric dentists on the current state of pediatric dentists and policy establishment. An Online survey was conducted among pediatric dentists. The questionnaire was subdivided into 'general characteristics', 'number of dental treatments and working days per year', 'proportion of covered services', 'perceptions of supply and demand of pediatric dentists'. Through the Korean Academy of Pediatric Dentistry, the Health Insurance Review and Assessment Services, the National Health Insurance Service (NHIS), and the Korean Statistical Information Service, the current state of pediatric dentists, the number of claims for covered services, and the decrease in births per year were investigated. Dental clinics claiming to be pediatric dentistry reached half of all medical institutions, but only 3.78% of pediatric dentists actually worked. 61.36% of all pediatric dentists were concentrated in the metropolitan area, showing a national imbalance. Although the population of children and adolescents have continuously decreased over the past 20 years, the number of NHIS-covered services has shown a continuous increase. Over the past 10 years, the optimal supply of pediatric dentists has been maintained at around 4,000. According to the analysis, 92.15% of pediatric dentists thought that it was necessary to prepare policies and support measures at the government level. This study is expected to be used as basic data for establishing a demand estimation method for pediatric dentistry specialists in the future.

• The Korean Journal of Air & Space Law and Policy
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• v.35 no.2
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• pp.137-168
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• 2020

Air passengers may be compensated for damages based on the above agreement when the passenger suffers an accident to the extent that they are recognized as an accident under Article 17 of the Montreal Convention in 1999. If a flight or cabin crew and passengers both undergo an accident, passengers are subjected to compensation under the Montreal Convention however flight cabin crews will be compensated by the Labor Law, which is the governing law in the labor contract with the airline. The flight or cabin crew boarding the aircraft work is on a work contract, not a passenger transport contract. Therefore, if the flight or cabin crew on the aircraft is injured due to an accident, and the air carrier is liable for default due to a labor contract, the Labor Law, workers or survivors claim damages due to illegal acts against the employer. In which case, civil law will apply. In this regard, if a Chinese cabin crew working for a Chinese airline dies due to an accident in the Republic of Korea, whether the family of the deceased claims damages against the Chinese airline or not has international court jurisdiction in the Republic of Korea, which is the place of tort. We examined whether it is the law of the Republic of Korea or whether it's the Chinese law, the law applicable to the work contract, is applied. Also, Seoul District Court 1995.5.18. The sentence 94A 14144 was found that if the injured crew during the flight work was not satisfied with the insurance compensation under the Labor Standards Act and the Industrial Accident Compensation Insurance Act, he could claime to damage under the civil law against an air carrier or third parties responsible for the accident. This law case shows that you can claim a civil damage as a cause. In case of death due to an existing illness while on the way to work, the Korea Workers'Compensation and Welfare Service did not recognize the death of the deceased as an occupational accident, and the trial was canceled by the parents of the deceased for the survivor's benefit and funeral expenses. (Seoul Administrative Court 2017.8. 31. Although the sentence was judged as an occupational disaster in 2016, the 2016 8816 Decision), it was defeated in the appeals court (Seoul High Court 2018.7.19.Sentence 2017 No. 74186) and I criticized the judgment of the appeal by analyzing the deceased's disease and related the cause of it to workload. Sometimes, a flight or cabin crew is on board not for the flight duty such as transferring to another flight or returning to the home base or lay-over place after their scheduled flight, this is called "Deadheading". If the crew who is not considered the same as a passenger, but is not on duty, is injured in an accident, does the crew claim compensation for damages under the labor contract or whether the Montreal Convention is applied to the passenger. In conjunction with the discussion, there was a similar case, In re Mexico City Aircrash of October 31, 1979, 708 F.2d 400 (9th Cir. 1983), Demanes v. United Airlines, 348 F.Supp. 13 (C.D.Cal. 1972), Sulewski v. Federal Express Corp., 749 F.Supp. 506 (S.D.N.Y. 1990) and reviewed by the European Court of Justice (CJEU) at Wucher Helicopter GmbH and Euro-Aviation Versicherungs AG v. After examining several acts in several countries it's undeniably crucial to clearly understand the definition of "passenger" as stated in the Fridolin Santer case.