• Journal of Preventive Medicine and Public Health
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• 제56권1호
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• pp.67-76
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• 2023

Objectives: Previous studies have reported that people with disabilities are more likely to be impoverished and affected by excessive medical costs than people without disabilities. Public transfer income (PTI) reduces financial strain in low-income households. This study examined the impact of PTI on catastrophic health expenditures (CHE), focusing on low-income households and households with Medical Aid beneficiaries that contained people with disabilities. Methods: We constructed a panel dataset by extracting data on registered households with disabilities from the Korea Welfare Panel Study 2012-2019. We then used a generalized estimating equation model to estimate the impacts of PTI on CHE. A subgroup analysis was carried out to assess the moderating effects of family income levels and health insurance types. Results: As PTI increased, the odds ratio (OR) of CHE in households that contained people with disabilities decreased significantly (OR, 0.92; 95% confidence interval [CI], 0.89 to 0.94; p<0.001). In particular, PTI effectively reduced the likelihood of CHE for low-income households (OR, 0.85; 95% CI, 0.81 to 0.89; p<0.001) and those who received medical benefits (OR, 0.78; 95% CI, 0.68 to 0.89; p<0.001). Conclusions: This study highlights the positive effect of PTI on decreasing CHE. Household income and the health insurance type were significant effect modifiers, but economic barriers seemed to persist among low-income households with non-Medical Aid beneficiaries. Federal policies or programs should consider increasing the total amount of PTI targeting low-income households with disabilities that are not covered by the Medical Aid program.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 2004년도 제56차 추계 학술대회 연제집
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• pp.71.1-71.1
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• 2004

• Journal of Preventive Medicine and Public Health
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• 제49권1호
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• pp.53-60
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• 2016

Objectives: The purpose of this study is to examine the magnitude of and the factors associated with the downward mobility of first-episode psychiatric patients. Methods: This study used the claims data from the Korean Health Insurance Review and Assessment Service. The study population included 19 293 first-episode psychiatric inpatients diagnosed with alcohol use disorder (International Classification of Diseases, 10th revision [ICD-10] code F10), schizophrenia and related disorders (ICD-10 codes F20-F29), and mood disorders (ICD-10 codes F30-F33) in the first half of 2005. This study included only National Health Insurance beneficiaries in 2005. The dependent variable was the occurrence of downward mobility, which was defined as a health insurance status change from National Health Insurance to Medical Aid. Logistic regression analysis was used to assess factors associated with downward drift of first-episode psychiatric patients. Results: About 10% of the study population who were National Health Insurance beneficiaries in 2005 became Medical Aid recipients in 2007. The logistic regression analysis showed that age, gender, primary diagnosis, type of hospital at first admission, regular use of outpatient clinic, and long-term hospitalization are significant predictors in determining downward drift in newly diagnosed psychiatric patients. Conclusions: This research showed that the downward mobility of psychiatric patients is affected by long-term hospitalization and medical care utilization. The findings suggest that early intensive intervention might reduce long-term hospitalization and the downward mobility of psychiatric patients.

• 지역사회간호학회지
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• 제23권4호
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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.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.71-82
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• 2019

Objective : To determine the prevalence of osteoporosis (OP) and osteoporotic vertebral fracture (OVF) in people with Parkinson's disease (PD) in Korea and its association with socioeconomic status. Methods : Using Health Insurance Review and Assessment Service-National Inpatient Sample (HIRA-NIS) data from 2009 to 2013, we estimated the annual prevalence of PD, OP, and OVF and investigated its association with socioeconomic status using data from National Health Insurance (NHI) beneficiaries and Medical Aid (MA) recipients. This study was supported by research funding from Korean Society for Bone and Mineral Research 2015. There were no study-specific biases related to conflicts of interest. Results : The number of PD patients in the HIRA-NIS increased each year from 2009 to 2013. Among patients with PD, the standardized prevalence rates of OP and OVF increased from 2009 to 2013; from 23.2 to 27.8 and from 2.8 to 4.2, respectively. Among patients with PD with OP, the prevalence of OVF were 12.2% and 15.1% in 2009 and 2013, respectively. The standardized prevalence rates of PD with OP and PD with OVF were significantly higher in MA recipients than in NHI beneficiaries. Conclusion : The prevalence of PD both with OP and with OVF increased and the prevalence was higher in MA recipients than in NHI beneficiaries. These findings may suggest that age over 65 years, female and low income may be a significant factor related to PD occurring with OP and OVF.

• 한국노년학
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• 제36권3호
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• pp.595-609
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• 2016

이 연구의 목적은 지역사회기반의 자기관리지지중재가 골관절염 의료급여수급자의 환자활력, 관절유연성 및 건강 관련 삶의 질에 미치는 단기효과를 확인하기 위함이었다. 연구 설계는 자기관리지지중재의 효과를 검증하기 위하여 무작위 대조군 전후설계를 활용하였으며, 이 연구는 자기주도적 관절염질병관리 역량강화연구의 일부이다. 연구대상은 일 지역 고위험군 의료급여수급자 중에서 60명의 골관절염환자를 대상으로 실험군(n=30)과 대조군(n=30)에 무작위 할당하였다. 8회기로 구성된 자기관리지지중재는 대상자 중심의 케어를 전략으로 인지 정서 행위기술을 활용하였으며, 교육 훈련된 의료급여관리사에 의하여 제공되었다. 연구도구는 구조화된 설문지, 관절각도기 및 줄자를 활용하였다. 자료 분석방법은 기술적 통계와 ${\chi}^2-test$, Fisher's exact test, t-test, ANCOVA를 활용하였다. 실험군은 대조군에 비하여 자기관리를 위한 환자활력, 관절유연성이 유의하게 증가되었으나 건강 관련 삶의 질 수준은 유의한 차이가 없었다. 향후에는 자기관리지지중재에 대한 장기(9 and 12-month follow up) 효과가 제시될 필요가 있다.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 1999년도 제51차 추계 학술대회 연제집
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• pp.77-78
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• 1999

• 보건행정학회지
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• 제19권2호
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• pp.71-84
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• 2009

Objectives : The purpose of this study is to analyze the proportion of admission via the emergency room(the rest is ER) in an emergency medical center and to examine the factors related to admission. Methods : This study used 2005 National Health Insurance claims data for admitted patients of 112 hospitals having emergency medical centers in Korea. The study sample had 2,335,610 patients. The data was classified into emergency admission and non-emergency admission. To investigate the factors affecting the type of admission, the following were included as independent variables: type of health assurance_(national health insurance beneficiaries or medical aid beneficiaries), demographic characteristics_ (sex, age), cause of admission_ (disease or injury), whether an operation was performed or not, DRG severity level, the number of beds, and the location of the hospital. Data were analyzed using the Chi-square test for the differences in emergency admission rates for each variables, and multiple logistic regression analysis was used for identifying the factors affecting admission type. Results : The proportion of admission via the ER accounted for 40.6% of the total admission among hospitals having emergency medical centers. The risk of admission via ER was relatively high for patients who were male, the aged, the injured, the surgical patients, the patients having more severe symptoms, and the patients admitted the hospitals located in metropolitan areas, and the patients admitted the hospitals having 300-699 beds. Medical aid patients were more likely admitted through the emergency room than health insurance patients after other variables ware adjusted. Conclusions and Discussion : We analyzed the proportion of admission via the ER for the total admission rate of hospitals having an emergency medical center in Korea. And we explored the factors related to admission via the ER. This proportion may be used as an indicator of the adequacy of medical utilization or low accessibility to hospitals of patients with low socioeconomic status.

• 보건행정학회지
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• 제29권4호
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• pp.513-522
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• 2019

Background: South Korea operates a Medical Aid (MA) program targeting selected low-income individuals to ensure medical service delivery to the disadvantaged while enhancing self-sufficiency of work-capable beneficiaries. However, as reasons behind welfare exits are diverse and do not always infer poverty relief or the provision of appropriate levels of health care services, this study aimed to investigate the association between changes in MA status and health care utilization. Methods: This study used the 2006 to 2015 National Health Insurance claims data. The impact of changes in annual MA status on health care utilization (yearly number of outpatient visits, inpatient visits, length of stay, and emergency department [ED] visits) was investigated using the generalized estimating equation model. Results: In 117,943 adult subjects aged 20 to 64, compared to the 'MA to MA' group, the 'MA to MA exit' group showed general decreases in utilization (outpatient visits: β=-3.93, p<0.0001; hospital admissions: relative risk [RR], 0.87; 95% confidence interval [CI], 0.83-0.91; length of stay: β=-3.64, p<0.0001; ED visits: RR, 0.83; 95% CI, 0.77-0.90). Similar patterns were found in the 'MA exit to MA exit' group (outpatient visits: β=-5.72, p<0.0001; admissions: RR, 0.91; 95% CI, 0.87-0.94; length of stay: β=-5.87; p<0.0001; ED visits: RR, 0.81; 95% CI, 0.75-0.88). Likewise, in 74,747 older adult subjects aged 65 or above, the 'MA to MA exit' group showed reduced levels of utilization (outpatient visits: β=-1.51; p=0.0020), as well as the 'MA exit to MA exit' group (admissions: RR, 0.92; 95% CI, 0.89-0.95; length of stay: β, -5.45; p<0.0001; ED visits: RR, 0.90; 95% CI, 0.83-0.97). Conclusion: MA exit was associated with general decreases in health care utilization. Utilization patterns of individuals with experiences of receiving MA benefits should be monitored to promote the ideal use of health care services while preventing potential financial barriers present in accessing medical care.

• Journal of Korean Biological Nursing Science
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• 제24권3호
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• pp.161-170
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• 2022

Purpose: The purpose of this study was to investigate polypharmacy and potentially inappropriate medication (PIM) use in elderly patients admitted to hospitals after falls. Methods: The study surveyed 283 patients 65 or older admitted January 1-December 31, 2016. Data were collected from electronic medical records, and medications administered immediately prior to admission were examined. PIM use for patients was investigated using the Beers criteria, and data were analyzed by Chi-square test and independent ttest. Results: The average age of participants was 79.42± 8.16, and the study included 226 women (79.9%) and 57 men (20.1%). The average number of self-administered medications daily was 4.94± 3.68, and 55.1% took five or more medications. PIM use was found in 107 patients (37.8%). There was a significant difference in polypharmacy according to age, and the proportion of medical aid beneficiaries and prevalence of cardiocerebrovascular, endocrine, and other chronic diseases were higher in the polypharmacy and PIM use patients than in the non-polypharmacy and non-PIM use patients. The number of chronic diseases and medications taken were significantly high among polypharmacy and PIM use patients. Conclusion: It is necessary to minimize polypharmacy and PIM use, and establish a system for systematically evaluating and managing medication use to prevent falls in the elderly.