• Title/Summary/Keyword: Insured Value

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Equity in the Delivery of Health care in the Republic of Korea (의료이용의 형평성에 관한 실증적 연구 -공.교 의료보험 피부양자를 대상으로-)

  • 명지영;문옥륜
    • Health Policy and Management
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    • v.5 no.2
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    • pp.155-172
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    • 1995
  • This study is an empirical analysis on the equity in the delivery of heatlh care under the Korean Medical Insurance Corporation System. The purposes of this study are to find out effects of income on the health care utiliztion and measure the income-related inequity in the distribution of health care. This study was carried out based on the fact that the health insurance program has been organized to achieve the equity objective, "equal treatment for equal needs". Of 41, 828 insured persons who had been diagnosed in the 1993 Health Screening Test and utilifzation data from 1, January 1993 through 31, December 1993 were derived from the Benefit Managment File. Inequity was measured by means of I) share approach, ii) standardization concentration curve approach, iii) inequity index, iv) test for inequity. The major findings were as follows : 1. The expenditure shares of the top two quintile groups exceeded their morbidity shares, whereas the opposite was true of the bottom three quintile groups, Which showed a positive HI$_{LG}$ inequity index, suggesting the presence of some inequity favoring the rich group. 2. Compared with other residential areas, the rural area showed the highest positive HI$_{LG}$ irrespective of need indicatior applied. 3. Standardized expenditure concentration indices adjusted by age, gender and need structure were also found to be positive, and therefore still indicated that there has been inequity favoring the rich after the standardization. 4. The Loglikelihood Ratio (LR) test for the statistical significance of income-related inequity of medical care utilization was carried out using the logistic regression model. The resulting loglikelihood ratio test statistic value was 176, which did exceed the 0.5 percent critical value of the chi-square distribution with 28 degrees of freedom, which is 50.993. Therefore, the null hypothesis of no income-related inequity of medical care utilization was rejected at the 99.5 percent confidence level. 5. The Regression based F-test has been carried out for analyzing the income-related inequity of medical expenditure in terms of age, gender, morbidity indicators as explanary variables. The hypothesis of the absence of income-relate inequity was rejected for all need indicators at the 95% confidence level.nce level.

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General Radiography Usage and Exposure Dose of Korean Elderly: Based on Data from Aged Patients in 2016 (한국 노인의 일반촬영 이용량 및 피폭선량: 2016년 고령환자데이터 기반)

  • Gil, Jong-Won;Yoo, Se-Jong;Lee, Won-Jeong
    • Journal of radiological science and technology
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    • v.44 no.5
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    • pp.495-502
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    • 2021
  • This study aims to provide basic data for elderly health insurance policy and medical radiation safety management by analyzing the general radiography usage and exposure dose of the elderly in Korea. The effective dose for each general radiography was calculated using the ALARA-GR program for 260 general radiography codes selected from 'National Health Insurance Care Benefit Cost'. The usage of general radiography was analyzed in the 2016 elderly patient data of the Health Insurance Review and Assessment Service, and the effective dose for each general radiography was applied. The general radiography usage and exposure dose per person aged 65 years and over was 6.47 cases and 0.56 mSv. Females showed higher value than males as 7.15 cases and 0.66 mSv(p<.001). By age, those between 75 and 79 showed the highest number as 6.97 cases and 0.62 mSv(p<.001). Those who were supported by Medical Aid showed higher value than those who were insured by National Health Insurance as 8.82 cases and 0.76 mSv(p<.001). In addition, the ratio by radiography was in the order of Chest 20.85%, Knee Joint 15.58%, and L-spine 14.67%, and the exposure dose was L-spine 29.40%, Chest 15.82%, Abdomen 7.97%, and Entire Spine 7.20%. General radiography, which is widely used due to the high frequency of diseases in the elderly population should be taken into consideration when establishing health insurance policies. In addition, it is necessary to check whether the general radiography with high exposure dose is performed as a routine examination without considering medical necessity.

Generic Utilization in the Korean National Health Insurance Market; Cost, Volume and Influencing Factors (한국 국민건강보험시장에서의 제네릭 의약품 사용 양상과 영향 요인)

  • Lee, Iyn-Hyang;Park, Sylvia;Lee, Eui-Kyung
    • YAKHAK HOEJI
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    • v.58 no.2
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    • pp.99-106
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    • 2014
  • This study explores the prescribing pattern of generic drugs and the relationship between socio-demographic factors and the use of generics in South Korea. The analysis was based on claims data of 2011 from Korean National Health Insurance. We examined utilization, costs, and market share of oral preparations by original and generic product. Multiple logistic regression was performed to evaluate the predictive factors of generic use among multi-source medications. Generics accounted for 37~41% of utilization and 34~41% of costs in the insured market of oral preparations. In the generic market, costly generics made up about 58~61%, 56~66% of volume and value, respectively. Other things being equal, institutional factors affected generic use to the largest degree. The odds of having generics were 6 times higher in clinics, 4 times higher in hospitals, and 1.7 times higher in general hospitals than in teaching hospitals. Those in metropolitan or rural area were more likely to prescribe generics than those in the capital area. While generics were frequently prescribed for off-site pharmacy (OR=1.173), the odds of having generics was 0.88 after weighting the data by units prescribed. This study empirically presented the pattern of generic prescribing, confirming the widely accepted view that costly generics were more likely to be utilized in the Korean market. Up to two thirds of the generic market consisted of costly products. The strongest factors affecting generic use were institutional variables.

The Study of Difference on Each System for Reliance Security in SUV of PET/CT Images : Initial Study (PET/CT 영상에서의 표준섭취계수(SUV)의 신뢰성 확보를 위한 시스템별 차이에 관한 연구 : 초기 연구)

  • Park, Hoon-Hee;Park, Min-Soo;Kim, Jung-Yul;Lee, Seung-Jae;Sheen, Hee-Soon;Lim, Han-Sang;Kim, Sei-Young;Jang, Hye-Won;Oh, Ki-Back;Kim, Jae-Sam;Lee, Chang-Ho
    • Korean Journal of Digital Imaging in Medicine
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    • v.10 no.1
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    • pp.5-6
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    • 2008
  • In this study, using an experiment, in certified an error between each system of SUV (standardized uptake value) that is one of the main analyses to diagnose a tumor in PET/CT, so, it would assure reliability and help to diagnose any lesions accurately. That is, a detailed analysis progressed. as all images reconstructed every setting time, then, clinical reliability between each system was expressed numerically at MBq/mL and SUV. Therefore, this study is considered that flexibility of follow-up using diverse system was insured, and it helps to offer accurate and beneficial information for diagnosis of various fields.

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General Radiography Imaging Usage and Effective Dose of Inpatients: Based on Data from Inpatients in 2018 (입원환자 일반촬영 이용량 및 피폭선량: 2018년 입원환자데이터)

  • Jong-Won Gil
    • Journal of radiological science and technology
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    • v.47 no.2
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    • pp.107-116
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    • 2024
  • In this study, we analyzed the use of general radiography imaging and effective dose in inpatients. Our aim is to help reduce national medical radiation exposure doses and develop rational health-care financial policies. The effective dose for each general radiography was calculated using the ALARA-GR program for 53 types (total: 260 codes) general radiography codes selected from 'National Health Insurance Care Benefit Cost'. The usage of general radiography was analyzed in the 2018 inpatient patient data of the Health Insurance Review and Assessment Service, and the effective dose for each general radiography was analyzed. 89.00% of inpatients undergo general radiography imaging at least once, with an average of 12.63 scans per person and an effective dose of 1.00 mSv. Those who received support from Medical Aid showed a higher value compared to those who were insured by National Health Insurance, with 17.39 cases and 1.43 mSv (p<.001). Chest had the highest usage rate at 23.12% for general radiography imaging, while L-spine had the highest effective dose at 24.53%. It is estimated that 420 inpatients patients undergo 121 to 820 general radiography imaging procedures per year, and 233 inpatients are estimated to have an annual effective dose of >20.00~58.25 mSv. Rational use of health-care finances and the practice of medical radiation safety management are essential for the well-being of individuals, the enhancement of quality of life, and the improvement of health-care quality.

Development of Customer Satisfaction VE Process during Design Phase using Axiomatic Design Theory (공리적 설계를 활용한 고객만족형 설계VE 프로세스 개발)

  • Park, In-Woo;Cho, Kyu-Man;Hyun, Chang-Taek;Hong, Tae-Hoon
    • Korean Journal of Construction Engineering and Management
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    • v.10 no.3
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    • pp.111-121
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    • 2009
  • Value Engineering(VE) at design phase(so-called Design-VE) becomes quite a compulsory solution for better customer satisfaction, cost reduction, higher product performance, and, eventually, insured predominance in the competition. Unlike intended, however, the customer requirement on Design-VE has not been fully reflected in reality. Furthermore, the Design-VE occasionally does not progress in regular sequence; Preparation for measuring customer requirement - Function analysis - Idea creation. Therefore, this study suggests Axiomatic Design Theory to be adopted in Design-VE process expecting that the functions required by the customer could systematically reflected in VE process. Post-occupancy Evaluation(POE) is also represented as a method to measure and arrange the customer requirements. The customer satisfaction Design-VE process creates ideas defining functions in more detailed, to reflect the concrete user requirement. This approach helps function analysis and idea creation linked closely because function and idea are developed zigzag (i.e. function - idea - function...) in being decomposed into level down. The application of the process proposed by this study will be helpful to improve the customer requirement measurement and clarify a link between functions and ideas.

A Study on the Ratio of Weight-far-Height in Insurance Medicine (비체중(比體重)의 보험의학적고찰(保險醫學的考察))

  • Im, Young-Hoon
    • The Journal of the Korean life insurance medical association
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    • v.2 no.1
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    • pp.195-217
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    • 1985
  • A statistical analysis on the ratio of weight-for-height in insurance medicine was carried out in a total of 12,690 insured persons who were medically examined at the Honam medical department, Dong Bang life insurance company, ltd. from June, 1979 to February, 1984. The results were as follows: 1. The mean value of the ratio of weight-for-height(W/H ratio) was $102.3{\pm}11.3%$ in all males, and $105.2{\pm}103.6%$ in all females. The difference of the values between males and females showed statistical significance(P<0.001). The mean value of W/H ratio in all the insureds was $103.8{\pm}12.9%$. In each age group, the mean value of female was higher than that of male without exception(P<0.001). The mean value of both sexes in each age group showed gradual increase with age except for the age group over 50(P<0.001). 2. The incidences of the average weighted, overweighted and underweighted lives were respectively 91.6% in all males, 84.2% in all females(P<0.001); 7.9% in all males, 15.4% in all females(P<0.001); 0.5% in all males, 0.4% in all females(P>0.05). The incidences of average weighted, overweighted and underweighted lives in all the insureds were respectively 87.6%, 12.0% and 0.5%. The incidence of the average weighted lives in male in each age group was always higher than that in female with the exception of the age group below 19(P<0.001), whereas the incidence of the overweighted lives in male in each age group was always lower than that in female(P<0.05 in the age group below 19, P<0.001 in the other age groups). The incidence of average weighted lives of both sexes in each age group showed gradual decrease with age from the second to fifth decade(P<0.001), whereas the incidence of the overweighted lives of both sexes in each age group showed gradual increase with age from the second to fifth decade(P<0.001). 3. The relative frequency distribution polygons of W/H ratio of both sexes drawn in a pair on one coordinate plane revealed lying in juxtaposition each other horizontally and showed the shifting of female's polygon to male's one toward the direction of greater value of W/H ratio at a short distance which increased gradually with age. 4. Correlations between both sexes and among age groups relating to W/H ratios of the insureds seem to be a physiological phenomenon of body build and should be considered on the rating of the build. Author prepared a rating table of build based on the correlations above menthioned. Some gradients by sex and age in the rating table of build are organized; in female group, the ratings of 0, 30-50, 50-100 and 100-D are to calculate by the build with W/H ratio of 80-125%, $126{\sim}145%,\;146{\sim}165%$ and over 166% respectively in the age group of 29 or under, by the build with W/H ratio of $80{\sim}130%,\;131{\sim}150%,\;151{\sim}170%$ and over 171% respectively in the age group of $30{\sim}59$, and by the build with W/H ratio of $80{\sim}135%,\;136{\sim}155%,\;156{\sim}175%$ and over 176% respectively in the age group of 60 or over. In male group, the ratings of 0, $30{\sim}50$, 50-100, and 100-D are to calculate by the build with W/H ratio of $80{\sim}120%,\;121{\sim}140%,\;141{\sim}160%$ and over 161% respectively in all ages. Of under weighted lives, in both sexes, the ratings of 30-50 and 50-D are to calculate by the build with W/H ratio of $76{\sim}79%$ and under 75% respectively. The results of the ratings according to a rating table by author were as follows: The incidence of the ratings of 0, 30-50, 50-100 and 100-D showed no difference between male and female. The incidence of the ratings of 0(indicating the average weighted lives) showed gradual decrease with age and the incidence of the ratings of 30-50 and 50-100(indicating the overweighted lives) showed gradual increase with age. These results are thought to be considerably reasonable because the incidence of the builds in each age group is supposed to have no difference by sex and the incidence of the overweighted lives would increase with age.

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Long-Term Prospects for a Minimum Living Guarantee by the Public Pension of Korea: Evaluation using Dynamic Micro-Simulation Model (공적연금의 최저생계 보장 효과에 대한 장기 전망)

  • Kwon, Hyukjin;Ryu, Jaerin
    • The Korean Journal of Applied Statistics
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    • v.28 no.4
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    • pp.741-762
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    • 2015
  • This study examines the long-term prospects for a minimum living guarantee by public pensions for the elderly using a dynamic micro-simulation model. "Elderly poverty" here is an estimate calculated by considering only the public pension income and it means how public pension affects the minimum living guarantee for the elderly. The main results are: First the impact of the public pension system on elderly poverty can be decomposed into economic growth and institutional effect. When considering both effects, the absolute poverty rate of the elderly will be reduced to 20% by the year 2040. But when considering the institutional effect(except economic growth effect), that rate is expected to be a long-term level of around 90%. Second, even if the Basic Pension is indexed to 10% of A-value, the elderly poverty rate is only about 10%p to be reduced further, compared to the current CPI-indexed system. Third, current benefit formula for National Pension does not consider the actual correlation of income level and insured period; consequently, the reversal possibility of the replacement rate appears likely. Fourth, the reform of 2007 improves the sustainability of the National Pension; however, it deteriorates the adequacy of the pension policy, i.e., the past system would be better than the current system in regards to a reduction in elderly poverty. Further discussion is needed on aspects of correct pension reform assessments which is difficult to achieve without understanding the comprehensive benefits and costs to society.

A basic research for evaluation of a Home Care Nursing Delivery System (가정간호 서비스 질 평가를 위한 도구개발연구)

  • Kim, Mo-Im;Cho, Won-Jung;Kim, Eui-Sook;Kim, Sung-Kyu;Chang, Soon-Bok;Ryu, Ho-Sihn
    • Journal of Home Health Care Nursing
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    • v.6
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    • pp.33-45
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    • 1999
  • The purpose of this study was to develop a basic framework and criteria for evaluation of quality care provided to patients with the attributes of disease in the home care nursing field, and to provide measurement tools for home health care in the future. The study design was a developmental study for evaluation of hospital-based HCN(home care nursing) in Korea. The study process was as follows: a home care nursing study team of College of Nursing. Yonsei University reviewed the nursing records of 47 patients who were enrolled at Yonsei University Medical Center Home Care Center in March, 1995. Twenty-five patients were insured at that time, were selected from 47 patients receiving home care service for study feasibility with six disease groups; Caesarean Section (C/S), simple nephrectomy, Liver cirrhosis(LC), chronic obstructive pulmonary disease(COPD), Lung cancer or cerebrovascular accident(CVA). In this study, the following items were selected : First step : Preliminary study 1. Criteria and items were selected on the basis of related literature on each disease area. 2. Items were identified by home care nurses. 3. A physician in charge reviewed the criteria and content of selected items. 4. Items were revised through preliminary study offered to both HCN patients and discharged patients from the home care center. Second step : Pretest 1. To verify the content of the items, a pretest was conducted with 18 patients of which there were three patients in each of the six selected disease groups. Third step : Test of reliability and validity of tools 1. Using the collected data from 25 patients with either cis, Simple nephrectomy, LC, COPD, Lung cancer, or CVA. the final items were revised through a panel discussion among experts in medical care who were researchers, doctors, or nurses. 2. Reliability and validity of the completed tool were verified with both inpatients and HCN patients in each of field for researches. The study results are as follows: 1. Standard for discharge with HCN referral The referral standard for home care, which included criteria for discharge with HCN referral and criteria leaving the hospital were established. These were developed through content analysis from the results of an open-ended questionnaire to related doctors concerning characteristic for discharge with HCN referral for each of the disease groups. The final criteria was decided by discussion among the researchers. 2. Instrument for measurement of health statusPatient health status was measured pre and post home care by direct observation and interview with an open-ended questionnaire which consisted of 61 items based on Gorden's nursing diagnosis classification. These included seven items on health knowledge and health management, eight items on nutrition and metabolism, three items on elimination, five items on activity and exercise, seven items on perception and cognition, three items on sleep and rest, three items on self-perception, three items on role and interpersonal relations, five items on sexuality and reproduction, five items on coping and stress, four items on value and religion, three items on family. and three items on facilities and environment. 3. Instrument for measurement of self-care The instrument for self-care measurement was classified with scales according to the attributes of the disease. Each scale measured understanding level and practice level by a Yes or No scale. Understanding level was measured by interview but practice level was measured by both observation and interview. Items for self-care measurement included 14 for patients with a CVA, five for women who had a cis, ten for patients with lung cancer, 12 for patients with COPD, five for patients with a simple nephrectomy, and 11 for patients with LC. 4. Record for follow-up management This included (1) OPD visit sheet, (2) ER visit form, (3) complications problem form, (4) readmission sheet. and (5) visit note for others medical centers which included visit date, reason for visit, patient name, caregivers, sex, age, time and cost required for visit, and traffic expenses, that is, there were open-end items that investigated OPD visits, emergency room visits, the problem and solution of complications, readmissions and visits to other medical institution to measure health problems and expenditures during the follow up period. 5. Instrument to measure patients satisfaction The satisfaction measurement instrument by Reisseer(1975) was referred to for the development of a tool to measure patient home care satisfaction. The instrument was an open-ended questionnaire which consisted of 11 domains; treatment, nursing care, information, time consumption, accessibility, rapidity, treatment skill, service relevance, attitude, satisfaction factors, dissatisfaction factors, overall satisfaction about nursing care, and others. In conclusion, Five evaluation instruments were developed for home care nursing. These were (1)standard for discharge with HCN referral. (2)instrument for measurement of health status, (3)instrument for measurement of self-care. (4)record for follow-up management, and (5)instrument to measure patient satisfaction. Also, the five instruments can be used to evaluate the effectiveness of the service to assure quality. Further research is needed to increase the reliability and validity of instrument through a community-based HCN evaluation.

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Lung cancer, chronic obstructive pulmonary disease and air pollution (대기오염에 의한 폐암 및 만성폐색성호흡기질환 -개인 흡연력을 보정한 만성건강영향평가-)

  • Sung, Joo-Hon;Cho, Soo-Hun;Kang, Dae-Hee;Yoo, Keun-Young
    • Journal of Preventive Medicine and Public Health
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    • v.30 no.3 s.58
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    • pp.585-598
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    • 1997
  • Background : Although there are growing concerns about the adverse health effect of air pollution, not much evidence on health effect of current air pollution level had been accumulated yet in Korea. This study was designed to evaluate the chronic health effect of ai. pollution using Korean Medical Insurance Corporation (KMIC) data and air quality data. Medical insurance data in Korea have some drawback in accuracy, but they do have some strength especially in their national coverage, in having unified ID system and individual information which enables various data linkage and chronic health effect study. Method : This study utilized the data of Korean Environmental Surveillance System Study (Surveillance Study), which consist of asthma, acute bronchitis, chronic obstructive pulmonary diseases (COPD), cardiovascular diseases (congestive heart failure and ischemic heart disease), all cancers, accidents and congenital anomaly, i. e., mainly potential environmental diseases. We reconstructed a nested case-control study wit5h Surveillance Study data and air pollution data in Korea. Among 1,037,210 insured who completed? questionnaire and physical examination in 1992, disease free (for chronic respiratory disease and cancer) persons, between the age of 35-64 with smoking status information were selected to reconstruct cohort of 564,991 persons. The cohort was followed-up to 1995 (1992-5) and the subjects who had the diseases in Surveillance Study were selected. Finally, the patients, with address information and available air pollution data, left to be 'final subjects' Cases were defined to all lung cancer cases (424) and COPD admission cases (89), while control groups are determined to all other patients than two case groups among 'final subjects'. That is, cases are putative chronic environmental diseases, while controls are mainly acute environmental diseases. for exposure, Air quality data in 73 monitoring sites between 1991 - 1993 were analyzed to surrogate air pollution exposure level of located areas (58 areas). Five major air pollutants data, TSP, $O_3,\;SO_2$, CO, NOx was available and the area means were applied to the residents of the local area. 3-year arithmetic mean value, the counts of days violating both long-term and shot-term standards during the period were used as indices of exposure. Multiple logistic regression model was applied. All analyses were performed adjusting for current and past smoking history, age, gender. Results : Plain arithmetic means of pollutants level did not succeed in revealing any relation to the risk of lung cancer or COPD, while the cumulative counts of non-at-tainment days did. All pollutants indices failed to show significant positive findings with COPD excess. Lung cancer risks were significantly and consistently associated with the increase of $O_3$ and CO exceedance counts (to corrected error level -0.017) and less strongly and consistently with $SO_2$ and TSP. $SO_2$ and TSP showed weaker and less consistent relationship. $O_3$ and CO were estimated to increase the risks of lung cancer by 2.04 and 1.46 respectively, the maximal probable risks, derived from comparing more polluted area (95%) with cleaner area (5%). Conclusions : Although not decisive due to potential misclassication of exposure, these results wert drawn by relatively conservative interpretation, and could be used as an evidence of chronic health effect especially for lung cancer. $O_3$ might be a candidate for promoter of lung cancer, while CO should be considered as surrogated measure of motor vehicle emissions. The control selection in this study could have been less appropriate for COPD, and further evaluation with another setting might be necessary.

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