• The Journal of the Korean life insurance medical association
• /
• v.1 no.1
• /
• pp.88-95
• /
• 1984

In Korea, life insurance policies are sold to the policy holders by insuring either the insureds undergo a medical examination at a clinic or the insureds' report their history of diseases ever experienced that replaces the medical examination. This study aimed to measure the level of death rates for the insureds between those who received medical examination and those who did not receive medical examination, and to examine differences of the rates in terms of the insureds' characteristics such as age, sex, cause of death and duration. A total number of 32,358 insureds were selected for the population of this study from the D. Life Insurance Company located in Seoul City. Out of the 32,358 insureds, 2,997 received medical examination and the rest of 29,381 did not received any medical examination. Results of analysis are summarized as follows: 1. Death rate per 100,000 insureds for the all was 19.3 in the first year, 96.3 in the second year, 143.8 in the third year 93.4 in the fourth year. For the group of medical examination received, the rate was zero in the first year, 41.3 in the second year, 55.4 in the third year and 268.8 in the fourth year, and for the group of non-medically examined the rate was 21.3 in the first year, 101.9 in the second year, 152.2 in the third year and 76.8 in the fourth year. The levels of death rates between the insureds with medical examsination and the inureds without medical examination were non-significant in the differences by duration except the levels of the third year, which indicated the death rate of non-medically examined group was higher than that of the medically examined group. 2. 73.0 per cent of the total deaths observed during the insured period were caused by various diseases and the rest of 27.0 per cent deaths were due to accidents. For the group of medical examination received, 55.6 per cent deaths were caused by diseases, and for the group of nonmedically examined, 74.7 per cent of deaths were due to diseases. 3. cancer was the most frequent cause which accounted for 22.0 per cent of the total deaths. Proportion of deaths due to cancer from the group of medical examination received was 22.2 per cent, and the corresponding rate for the group of non-medically examined also showed high rate of 22.0 per cent.

• Journal of Home Health Care Nursing
• /
• v.12 no.2
• /
• pp.63-86
• /
• 2005

Purpose: This study is a descriptive research which is designed to investigate hospitalized patients' intent to use home care nursing according to the types of medical security. Method: This researcher surveyed 236 patients who were hospitalized at B medical center located in Busan,. Data were collected from Sep. 1 to Nov. 30, 2005 using a questionnaire survey, medical records, face-to-face interviews and observations. Collected data were analyzed in terms of frequency, percentage, mean and standard deviation through $x^2$-test and t-test under SPSS WIN 10.0 Program. Result: Out of the total subjects, 59.3% were medical aid clients and the remaining 40.7%, health insurance ones. The hospitalized period and frequency of the former group were 38.0 days and 4.0 times, respectively, while those of the latter, 37.7 and 3.4. When home care nursing clients were examined using a given classification device, it was found that out of the total 236 subjects, 205(86.9%) were needed to receive home care nursing, 121, medical aid and the other 84, health insurance. 24.0% of medical aid clients heard about home care nursing ever before, lower than 39.3% of health insurance clients. 43.8% of the former clients said cost for home care nursing was high while, 47.6% of the latter group responded expense for the nursing intervention was low. 30.6% of medical aid clients had intent to use home care nursing, lower than 47.6% of health insurance clients. 71.7% of those patients whose monthly income was 99 million won or below had no intent to use home care nursing, higher than 62.5% of those who were 100 million or over in monthly income(p<.05). 76.4% of those clients who had no nursing provider intented to use home care nursing, higher than those who had nursing provider(p<.05). Concerning contents of home care nursing, 85.1% of medical aid clients needed education, training and counseling while, 77.4% of health insurance aids wanted medication and injection. Conclusion: In conclusion, the use of home care nursing by medical aid clients should be promoted through improving conditions for home care nursing in terms of expense, family and residence and making public relations about activities and contents of the home care nursing.

• Health Policy and Management
• /
• v.11 no.3
• /
• pp.46-70
• /
• 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
• /
• v.29 no.3 s.54
• /
• pp.555-563
• /
• 1996

Nationwide incidence survey was conducted to estimate the annual incidence rates of colorectal cancer among Koreans between Jan 1, 1988 and Dec 31, 1989. The population of the incidence survey was the beneficiaries of Korea Medical Insurance Corporation (KMIC), which were about 4,500,000 persons. The medical records of patients with diagnosis of either ICD-9 153(colon cancer), 154(rectal caner), 197(secondary malignant neoplasm of digestive and respiratory system), or 211(benign neoplasm of digestive system) were abstracted for the period with the standard format. The diagnosis was confirmed by one oncologist through the review of these abstracts. The numerator of the rate was finally defined as the incident colorectal cancer cases diagnosed between July 1, 1988 and June 30, 1989. The crude annual incidence of colorectal cancer for men was 13.1 per 100,000 and 10.6 for women, which was still low when compared with those of Japan and China during the same period. Age-adjusted sex ratio was 1.2 for right-sided colon cancer and 1.9 for left-sided colon cancer. The excess of right colon cancer among postmenopausal women was remarkable, so further analytical approach would be needed to investigate which factors are related with this phenomenon.

• Journal of Gastric Cancer
• /
• v.1 no.2
• /
• pp.113-118
• /
• 2001

Purpose: The common features of brain metastases from gastric cancer are unknown because brain metastasis is an uncommon pattern of metastasis. The purpose of this study was to investigate the clinical features of and the prognosis for patients with brain metastases after a curative resection for gastric cancer. Materials and Methods: Twenty-one (21) cases of patients with brain metastases of gastric cancer, who had been treated at the Department of Surgery, Yonsei University College of Medicine, were assessed retrospectively. Results: The mean age was $55.8\pm9.6$ years (range: $34\~70$ years), and the male-to-female ratio was 2.5 : .1. The most common neurologic symptom was headache ($38.5\%$), and no patient was free from the neurologic symptoms. The incidence of parenchymal metastasis (PM: $76.2\%$) was higher than that of leptomeningeal metastasis (LM: $19.0\%$). Patients with gastric cancer and brain metastasis showed high rates of blood and lymphatic vessel invasion (lymphatic vessel invasion: $85.7\%$; blood vessel invasion: $80.9\%$). According to Lauren's classification, the incidence of intestinal types was 14/21 ($66.7\%$), that of diffuse types was 3/21 ($14.3\%$) and that of mixed types was 4/21 ($19.0\%$). The mean interval between the gastrectomy and the diagnosis of brain metastasis was $24.7\pm4.0$ months (PM: 26.8 months; LM: 20.3 months). The median period of survival after diagnosis of brain metastasis was 2 months for paren chymal metastasis and 0 months for leptomeningeal metastasis. Conclusion:.. During a follow-up period, patients with neurologic symptoms should be suspected of having brain metastasis. Early diagnosis and treatment is the only hope to prolong survival in such patients.

• Journal of Korean Neurosurgical Society
• /
• v.62 no.1
• /
• pp.46-52
• /
• 2019

Objective : The aim of this nationwide study was to analyze the current state of patients with newly diagnosed metastatic spine tumors according to surgical methods. Methods : Data was extracted from the Korean Health Insurance Review and Assessment Service database. Surgery was categorized into three methods : fusion, decompression, and vertebroplasty. Data included patient age, sex, health insurance type, and co-morbidities. Survival rates of metastatic spine tumor patients according to each surgical method were evaluated. Results : Among 1677 patients who had an operation, 823 patients were treated by fusion, 141 patients underwent decompression, and 713 patients were treated by vertebroplasty. The three most prevalent primary tumor sites were the lung, breast, and liver & biliary. On the other hand, the three most prevalent primary tumor sites of patients who underwent surgery were the lung, liver & biliary, and the prostate. The median survival periods for each surgical method in the metastatic spine tumor patients were 228 days for those who underwent surgery, 249 days for decompression, and 154 days for vertebroplasty. Age, sex, and comorbidities significantly affected survival rate. Conclusion : For every primary tumor site, decompression was the least common surgical method during the study period. Although the three surgical methods did not significantly affect the survival period, patients with a poor prognosis tended to undergo vertebroplasty.

• Journal of Preventive Medicine and Public Health
• /
• v.57 no.1
• /
• pp.65-72
• /
• 2024

Objectives: Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019. Methods: Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE. Results: The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (p<0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (p<0.05). Conclusions: Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.

• Journal of Preventive Medicine and Public Health
• /
• v.49 no.3
• /
• pp.143-152
• /
• 2016

Objectives: Metabolic syndrome is a cluster of risk factors for type 2 diabetes mellitus and cardiovascular disease. Associations between metabolic syndrome and several types of cancer have recently been documented. Methods: We analyzed the sample cohort data from the Korean National Health Insurance Service from 2002, with a follow-up period extending to 2013. The cohort data included 99 565 individuals who participated in the health examination program and whose data were therefore present in the cohort database. The metabolic risk profile of each participant was assessed based on obesity, high serum glucose and total cholesterol levels, and high blood pressure. The occurrence of cancer was identified using Korean National Health Insurance claims data. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, adjusting for age group, smoking status, alcohol intake, and regular exercise. Results: A total of 5937 cases of cancer occurred during a mean follow-up period of 10.4 years. In men with a high-risk metabolic profile, the risk of colon cancer was elevated (HR, 1.40; 95% CI, 1.14 to 1.71). In women, a high-risk metabolic profile was associated with a significantly increased risk of gallbladder and biliary tract cancer (HR, 2.05; 95% CI, 1.24 to 3.42). Non-significantly increased risks were observed in men for pharynx, larynx, rectum, and kidney cancer, and in women for colon, liver, breast, and ovarian cancer. Conclusions: The findings of this study support the previously suggested association between metabolic syndrome and the risk of several cancers. A high-risk metabolic profile may be an important risk factor for colon cancer in Korean men and gallbladder and biliary tract cancer in Korean women.

• Parasites, Hosts and Diseases
• /
• v.60 no.5
• /
• pp.327-338
• /
• 2022

This study determined the recent status and trend of Pneumocystis jirovecii pneumonia (PcP) in the non-human immunodeficiency virus (HIV) (non-HIV-PcP) and HIV (HIV-PcP) infected populations using data from the Health Insurance Review & Assessment Service (HIRA) and the Korea Disease Control and Prevention Agency (KDCA). SaTScan and Join-point were used for statistical analyses. Non-HIV-PcP cases showed an upward trend during the study period from 2010 to 2021, with the largest number in 2021 (551 cases). The upward trend was similar until 2020 after adjusting for the population. Seoul had the highest number of cases (1,597) in the non-HIV-PcP group, which was the same after adjusting for the population (162 cases/1,000,000). It was followed by Jeju-do (89 cases/1,000,000). The most likely cluster (MLC) for the non-HIV-PCP group was Seoul (Relative Risk (RR)=4.59, Log Likelihood Ratio (LLR)=825.531), followed by Jeju-do (RR=1.59, LLR=5.431). An upward trend was observed among the non-HIV-PcP group in the Jeju-do/Jeollanam-do/Jeollabuk-do/Gyeongsangnam-do/Busan/Daejeon/Daegu/Ulsan joint cluster (29.02%, LLR=11.638, P<0.001) located in the southern part of Korea. Both women and men in the non-HIV groups showed an overall upward trend of PcP during the study period. Men in the 60-69 age group had the highest annual percentage change (APC 41.8) during 2014-2019. In contrast, the HIV groups showed a falling trend of PcP recently. Men in the 60-69 age group had the most decrease (APC -17.6) during 2018-2021. This study provides an analytic basis for health measures and a nationwide epidemiological surveillance system for the management of PcP.

• Tuberculosis and Respiratory Diseases
• /
• v.85 no.1
• /
• pp.11-17
• /
• 2022

Background: In asthma, consistent control of chronic airway inflammation is crucial, and the use of asthma-controller medication has been emphasized. Our purpose in this study is to compare the incidence of acute exacerbation and healthcare costs related to the use of asthma-controller medication. Methods: By using data collected by the National Health Insurance Review and Assessment Service, we compared one-year clinical outcomes and medical costs from July 2014 to June 2015 (follow-up period) between two groups of patients with asthma who received different prescriptions for recommended asthma-controller medication (inhaled corticosteroids or leukotriene receptor antagonists) at least once from July 2013 to June 2014 (assessment period). Results: There were 51,757 patients who satisfied our inclusion criteria. Among them, 13,702 patients (26.5%) were prescribed a recommended asthma-controller medication during the assessment period. In patients using a recommended asthma-controller medication, the frequency of acute exacerbations decreased in the follow-up period, from 2.7% to 1.1%. The total medical costs of the controller group decreased during the follow-up period compared to the assessment period, from $3,772,692 to $1,985,475. Only 50.9% of patients in the controller group used healthcare services in the follow-up period, and the use of asthma-controller medication decreased in the follow-up period. Conclusion: Overall, patients using a recommended asthma-controller medication showed decreased acute exacerbation and reduced total healthcare cost by half.