• Journal of Korean Public Health Nursing
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• v.24 no.2
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• pp.237-248
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• 2010

Purpose: The study assessed the effects of a 12-session empowering program to promote health quality of life, decision making self-efficacy, self-care competency, and reasonable medical care utilization among low income women households in one rural area. Methods: A quasi-experimental, one-group pre-posttest design was employed. A total of 28 women enrolled as medicaid recipients in the Public Health Center of W city agreed to participate. The empowering program consisted of 12 sessions addressing health education for self-care of disease, medication management, and counseling for psycho-social support. The intervention was delivered by five nurses and one social worker. Women completed a structured questionnaire measuring the study variables with demographic characteristic before and after the intervention. Data were analyzed by PAWS Statistics 17 utilizing descriptive statistics and paired t-test. Results: After the intervention, significant increases were evident in participant health quality of life (t=-5.83, p<.001), decision making self-efficacy (t=-4.86, p<.001), self-care competency (t=-8.16, p<.001), and reasonable medical care utilization (t=-3.97, p<.001). Conclusion: The 12-session empowering program on health quality of life as well as self-care competency was effective when delivered to low income women households. Further studies with larger numbers of participants and a control group are necessary to validate the results.

• Health Policy and Management
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• v.32 no.2
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• pp.154-163
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• 2022

Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• Health Policy and Management
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• v.14 no.2
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• pp.1-16
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• 2004

The study purpose was to find which factors affect selection of hospital network types. This study used the 1998 American Hospital Association Annual Survey Database from Health Forum. Among these U.S. hospitals, the researcher selected hospitals located in Metropolitan Statistical Areas. Therefore the final observation cases for analysis are 1,971 Metropolitan Statistical Area hospitals in the United States. To identify significant variables influencing hospital network types, the study used proportional odds logistics regression model on population size, Health Maintenance Organization penetration rate, and market competition rate of area including a hospital, types of hospital ownership, hospital bed size, proportion of Medicare patients and Medicaid patients in total hospital patients, and occupancy rate. Contrary to conventional wisdom, selection of hospital network types was influenced by population size of area which a hospital located, types of ownership, hospital bed size, and proportion of medicare patients rather than Health Maintenance Organization penetration. Population size 1,000,000-2,499,999 had the highest probability of selecting type IV (clinical-vertical integration) from an independent hospital, and a religious group owned hospitals and for-profit owned hospitals had the highest probability of selecting Type IV (clinical-vertical integration) from an independent hospital. A bed size had positive relation on selecting Type IV (clinical-vertical integration) from an independent hospital. Unlikely general belief that the selecting types of hospital network was determined by the change of health insurance policy such as Health Maintenance Organizations and Preferred Provider Organizations, the types of hospital network were influenced by community characteristics such as population size, and hospital characteristics.

• Journal of Preventive Medicine and Public Health
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• v.40 no.1
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• pp.51-58
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• 2007

Objectives : The objectives of this study were to estimate the continuity of care for all Koreans with diabetes and to identify factors affecting the continuity of care. Methods : We obtained National Health Insurance claims data for patients with diabetes who visited health-care providers during the year 2004. A total of 1,498,327 patients were included as study subjects. Most Frequent Provider Continuity (MFPC) and Modified, Modified Continuity Index (MMCI) were used as indexes of continuity of care. A multiple linear regression analysis was used to identify factors affecting continuity of care. Results : The average continuity of care in the entire population of 1,498,327 patients was $0.89{\pm}0.17$ as calculated by MFPC and $0.92{\pm}0.16$ by MMCI. In a multiple linear regression analysis, both MFPC and MMCI were lower for females than males, disabled than non-disabled, Medicaid beneficiaries than health insurance beneficiaries, patients with low monthly insurance contributions, patients in rural residential areas, and patients whose most frequently visited provider is the hospital. Conclusions : The continuity of care for patients with diabetes is high in Korea. However, women, the disabled and people of low socio-economic status have relatively low continuity of care. Therefore, our first priority is to promote a diabetes management program for these patients.

• Health Policy and Management
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• v.19 no.1
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• pp.31-48
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• 2009

The objectives of this study were to evaluate the satisfaction of participants in the National Cancer Screening Program(NCSP) and to identify factors affecting the satisfaction. The telephone survey was conducted in July 2007 for the participants who were screened by the NCSP from January through May 2007. Student's t-tests and analysis of variance were performed first to determine if the mean satisfaction score differed by the characteristics of study objects, followed by multiple linear regression analyses to examine the factors affecting satisfaction. Dependent variable was general satisfaction for the screening service, and three dimensions of independent variables - 'sociodemographic characteristics', 'screening characteristics', and 'perceived service quality' - were used for the empirical analyses. Female, old-aged, less educated, Medicaid recipients, rural residents and the participants with normal results were more likely to be satisfied with the NCSP. The results of multiple regression analyses show that gender, age, location of residence, type of screening units, and perceived quality of screening services were significantly related to satisfaction. This study is meaningful as the first attempt to measure participant satisfaction with the NCSP, and to identify factors affecting the satisfaction. Among the identified factors, the NCSP needs to pay attention to perceived quality of service, in particular, to improve the satisfaction. This study is expected to contribute to raising the compliance rate and to improve the quality of the NCSP.

• Journal of Preventive Medicine and Public Health
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• v.17 no.1
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• pp.121-126
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• 1984

Several detailed aspects of medical care services during one year (Aug 1, $1982{\sim}$July 31, 1983) were compared between two community health sub-centers; one (A) was served by a local clinician, the other (B) by a trainee of preventive medicine. The results were analysed as follows: 1. Total spells of medical services during the same period in 'A' sub-center was 4,087 and that in 'B' 2,347. Medicaid visitors in 'A' was 1,051 (25.7% of the total), that in 'B' was 250 (10.7%). Significant difference was observed. 2. Average number of visits for the same case in 'A' was 2.0, that in 'B' was 1.4. Average duration of service by day for the same case in 'A' was 3.9, that in 'B' 3.0. 3. Average cost of service for a case in 'A' was 6,770 won, that in 'B' 4,230 won. 4. Difference in age distribution of visitors in the two sub-centers was insignificant. $0{\sim}9$ year group was 38.5% of the total. Difference in distribution by sex (between two sub-centers) was minimal. Male utilisers more than female by ca. 10%. 5. Concerning distribution of visitors by month, utilisation in July, August and September was the highest; the sum of them was 32.7% of the total in 'A' and 32.9% in 'B'. 6. Distribution by diagnoses in 'A' in decreasing order of frequency was Respiratory system diseases (26.1%), Digestive system diseases (23.0%), Diseases of skin and subcutaneous tissue (17.4%), Accidents and poisoning (11.5%) and Diseases of musculoskeletal system and connective tissue (5.4%). That in 'B' was Respiratory system diseases (39.0%), Digestive system diseases (23.0%), Diseases of skin and subcutaneous tissue (14.2%), Accidents and poisoning (10.9%) and Infection and parasitic diseases (9.1%). 7. The 10 most frequent diagnoses comprised 68.5% of the total in 'A' and 65.5% in 'B' 8. Utilisation by accessibility to each sub-center was studied. It is shown that the nearer the distance or the easier the accessibility, the more visits to services. The distinct pattern is manifested in the utilisation in 'A'-Myun.

• Health Policy and Management
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• v.22 no.2
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• pp.275-296
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• 2012

Graduate School of Public Health, Seoul National University The national health insurance system in Korea is characterized as relatively high out-of-pocket payments, which are the principal source of catastrophic health expenditure (CHE). The objectives of this study are to estimate the incidence of household CHE and to clarify the characteristics that affect the occurrence and recurrence of household CHE using the Seoul Welfare Panel Survey database for 2008 and 2010. Thresholds to estimate CHE were 10% and 20% of the total household income (T/X), and 25% and 40% of the income excluding food share (T/Y). Determinants of the occurrence and recurrence of CHE at the threshold of T/X=10% were analysed using multiple logistic regression models. Out of the 3,665 households that responded in 2008 survey, households with CHE were 12.07% (T/X${\geq}$10%), 5.34% (T/X${\geq}$20%), 6.84% (T/Y${\geq}$25%), and 4.44% (T/Y${\geq}$40%). Risk factors associated with household CHE included living with a spouse, non-Medicaid beneficiary, householder unemployment, low household income, the number of disabled members, poor subjective health, and the number of chronic diseases. A total of 41.78% of households with CHE in 2008 repeatedly experienced CHE in 2010. Risk factors of CHE recurrence included decreased household income and an increase in chronic diseases over the two time periods, the number of members with disability or chronic diseases, and the presence of cancer patients in 2008. Households with lower socioeconomic and health status had a higher financial burden on health care than do their counterpart households. There is a need to enhance society-wide financial protection from health spending among vulnerable citizens in Seoul, particularly, households with low income, disabled members or cancer patients.

• Health Policy and Management
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• v.32 no.2
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• pp.125-136
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• 2022

The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• Journal of agricultural medicine and community health
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• v.28 no.2
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• pp.87-105
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• 2003

Objectives: The purpose of this study was to examine the health care utilization pattern and its related factors of low-income population with abnormal results through health examination. Methods: Analysed data were collected through a questionnaire survey, which was given to 263 persons who 30 years or over with abnormal results through health examination at Health Center. This survey was conducted in March, 2003. This study employed Andersen's prediction model as most well known medical demand mode and data were analysed through 2-test, and multiple logistic regression analysis. Results: The proportion of medical utilization for thorough examination or treatment among study subjects was 51.0%. In multiple logistic regression analysis as dependent variable with medical utilization, the variables affecting the medical utilization were 'feeling about abnormal result(anxiety versus no anxiety: odds ratio 2.25, 95% confidence intervals 1.07-4.75)', 'type of health security(medicaid type I versus health insurance: odds ratio 2.82, 95% confidence intervals 1.04-7.66; medicaid type II versus health insurance: odds ratio 3.22, 95% confidence intervals 1.37-7.53)', 'experience of health examination during past 2 years(odds ratio 2.39, 95% confidence intervals 1.09-5.21)' and 'family member's response for abnormal result(recommendation for medical utilization versus no response: odds ratio 4.90, 95% confidence intervals 1.75-13.75; family member recommended to utilize medical facilities with him/her versus no response: odds ratio 19.47, 95% confidence intervals 5.01-75.73)'. The time of medical utilization was 8-15 days after they received the result(29.9%), 16-30 days after they receive the result(27.6%), 2-7 days after they received the result(20.9%) in order. The most important reason why they didn't take a medical utilization was that it seemed insignificant to them(32.4%). Conclusions: In order to promote medical utilization of low-income population, health education for abnormal result and its management would be necessary to family member as well as person with abnormal result. And follow-up management program for person with abnormal result through health examination such as home-visit health care would be necessary.

• Journal of Society of Preventive Korean Medicine
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• v.19 no.3
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• pp.29-43
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• 2015

Objective : The purpose of this study was to identify characteristics of patients' self-perceived health in traditional Korean medical facilities. Method : This research was conducted based on the survey on patients whom have visited traditional Korean medical facilities in 2011 by the Ministry of Health and Welfares and Korean Institute for Health and Social Affairs. Using a sample of 3,931 (1,180 male and 2,751 female) outpatients' self-perceived health based on the data from usage and consumption of Korean Medicine. 'Healthy', 'Fair', and 'Poor Health' were used to measure patients' self-perceived health status. The data was analyzed by frequency, t-test, cross correlation analysis and multiple logistics regression analysis using the SPSS program package. Results : Sex(P<0.001), age(P<0.001), marital status(P<0.001), education(P<0.001), employment status(P<0.001), occupation(P<0.001), health insurance(P<0.001) and income level(P<0.0001) showed statistical significance. Main Treatment Facilities(P<0.001), experience of taking Korean medicine(P=0.032), experience of receiving acupuncture treatment(P<0.001), number of visits(P<0.001), medical expense (P=0.005), and subjective health status after the treatments showed statistical significance for Korean herbal medicine(P=0.038), acupuncture (P=0.001), cupping therapy(P=0.006), oriental physiotherapy(P=0.003), and treatment satisfaction(P<0.001). For subjective health status based on suffering disorders in the past three months, the response of poor health was higher in the group suffering recent illnesses. Statistical significance was seen in hypertension (P=0.002), arthritis(P<0.001), lumbar pain(P<0.001), diabetes mellitus(P=0.001), stroke(P<0.001), hwa-byung (P=0.001), gastric disorders(P=0.021), common cold(P<0.001), ankle sprain(P<0.001), muscular injury(P<0.001), lumbar sprain(p=0.009) and fracture(P=0.03). Also the number of diseases during the past three months showed statistical significance(P<0.001). Statistical significance was also seen in Level of knowledge(P<0.001), route of information(P<0.001), reliability of Korean medicine(P=0.003), insurance coverage(P=0.005), medical costs(P<0.001), and future willingness to use Korean medicine(P<0.001). As a result of the multiple logistics regression analysis, risks of subjective poor health statistically increased in female population, elderlies, medicaid beneficiaries, less educated, higher medical expense, and more disorders during the past three months. Conclusion : Patients' self-perceived health status has significant differences with each variables such as sex, age, marital status, education, health insurance, medical expense, number of diseases.