• Korean Journal of Community Nutrition
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• v.17 no.3
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• pp.341-352
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• 2012

It is well established that excessive sodium intake is related to a higher incidence of chronic diseases such as hypertension, stroke, coronary heart disease, cardiovascular disease and gastric cancer. Although the upper limit of the current sodium intake guideline by WHO is set at 2,000 mg/day for adults, sodium intake of Koreans is well over 4,700 mg/capita/day implying an urgent need to develop and implement sodium intake reduction policy at the national level. This study investigated the cost-effectiveness of the sodium intake reduction policy, for the first time, in Korea. Analyses were performed using most recent and representative data on national health insurance statistics, healthcare utilization, employment information, disease morbidity/mortality, etc. The socioeconomic benefits of the policy, resulting from reduced morbidity of those relevant diseases, included lower medical expenditures, transportation costs, caregiver cost for inpatients and income losses. The socioeconomic benefits from diminished mortality included reductions in earning losses and welfare losses caused by early deaths. It is estimated that the amount of total benefits of reducing sodium intake from 4.7 g to 3.0 g is 12.6 trillion Korean Won; and the size of its cost is 149 billion Won. Assuming that the effect of sodium intake reduction would become gradually evident over a 5-year period, the implied rate of average return to the sodium reduction policy is 7,790% for the following 25 years, suggesting a very high cost-effectiveness. Accordingly, development and implementation of a mid-to-long term plan for a consistent sodium intake reduction policy is extremely beneficial and well warranted.

• Health Policy and Management
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• v.26 no.2
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• pp.135-147
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• 2016

Background: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. Methods: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. Results: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). Conclusion: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.595-601
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• 1993

Background: Today, tuberculosis continues as an important cause of death in Korea despite the effective treatment and prevention. So we have studied charicteristic distribution of death by pulmonary tuberculosis through epidemiologic survey. Subjects and Method: The mortality data were obtained from 684 pulmonary tuberculosis cases who died in a tuberculosis-centered hospital in Seoul during the period of 5 years from 1986 to 1990. In order to estimate the distribution of death by tuberculosis, t-test and $x^2$-text were performed on the data. Results: 1) 19.9% of patients died among the total 3,441 hospitalized pulmonary tuberculosis cases during 5 years. 2) In distribution of sex and age, male death occupies 81% of total death. Significantly high proportions of younger female death (under 40 years-old) were also observed. 3) In terms of medical security status, medical assistance group occupies 42.3% of medical insurance group while the non-security group also occupies 11.8% of total death. 4) Treatment interruption was observed in 78% of total death. Conclusion: Special attention should be given to the identification, management and follow up of high risk group in nationwide tuberculosis control program.

• Journal of Digital Convergence
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• v.14 no.6
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• pp.325-333
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• 2016

This study was conducted to provide the base line for the use of prophylactic antibiotics and the standard of antibiotic use and the evaluation based on analysis of current use, quality assessment and periodic changes of prophylactic antibiotics in a university hospital. We chose the year 2008, 2009, 2010, 2012, and 2014 as the study periods since the primary evaluation on the first year of implementation in 2007. For this study, healthcare benefit quality assessment data from the Health Insurance Review and Assessment Service was used. We analyzed the differences each year of treatment period; one category for initial treatment timing, three categories for selecting antibiotics, and two categories for the length of treatment from multiple evaluation indices of gastric surgeries, colorectal surgeries, and cholecystectomy. The analysis revealed the followings: Regarding length of antibiotics treatment, total days of treatment decreased down to 1.5, 1.5, and 0.6 days in the year 2014, from 13.5, 12.8, and 6.9 days in the year 2007, for gastric surgeries, colorectal surgeries, and cholecystectomy. Based on these outcomes, the efforts to devise efficient delivery and distribution of the recommendations or indices which medical staff could adhere for quality improvement of the prophylactic antibiotics would be necessary. Also implementing monitoring system to help the hospitals to acknowledge their own faults may be helpful.

• Journal of Society of Preventive Korean Medicine
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• v.11 no.2
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• pp.71-86
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• 2007

This study aims at looking into the use of oriental medical services in treating disease and patient's attitude of oriental medicine by social classes. The first to be explored through this study is medical accessibility, classifying them by age, gender and job. Second is to examine kinds of oriental medical services and expenses incurred in treating the disease. Third is to compare satisfaction for the services offered and investigate into relations between disease and oriental medicine through cross-analysis by class, and provide fundamental materials for enhancing accessibility to oriental medical centers for treating chronic diseases. The 1,376 households for the period of time from Apr. to Jun. 2005, were asked to answer to the questionnaires offered. The conclusion from the survey can be summarized as follows. Medical services for the onset of disease were less offered to females, older group, low schooling, and low-income bracket. It is attributable to an economic cause, in both genders. The in- and outpatients' rate were found higher in groups of female, older age, low-income and blue-color workers. Use of oriental medical centers were higher in outpatients than inpatients probably for low-income brackets were less frequently put on regular physical checkups, more exposing to diseases. Each hospitalization was found over six days longer in average; 19.7 days for oriental medical hospitals, 12.5 for hospitals. The hospital charges that patients should pay for one hospitalization showed 909,000 won in oriental medical hospitals, much higher than 518,000 won in hospitals. Outpatients were also found to pay more for oriental medical services; 55,000 won for oriental medical hospitals, 19,000 for hospitals. As to outpatients' satisfaction, oriental medical hospitals were generally found to be a little more satisfactory than general hospitals; 11.2% of respondents answered Very Satisfactory. Satisfaction to services offered to outpatients showed 82.2% of respondents responded to Over Satisfactory for herb clinics, 76% for general hospitals. For future intention to use oriental medical services, females, over 51 years old, lower education and income, and blue color workers showed more intention to use them. To be more competitive in treating chronic diseases, it is necessary that oriental medical services become more accessible through extending its coverage of insurance into more medical herbs and their prepared packs, as well as mapping out extensive publicity strategies to make known to the public about high efficacy of medical herbs and their safety.

• Journal of Society of Preventive Korean Medicine
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• v.24 no.2
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• pp.57-62
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• 2020

Objectives : This study is retrospective chart review research on the combined-prescription of Western and Korean medicine in Public Health Center in rural area. Methods : Researchers reviewed medical records of patients who was prescribed Korean medicine and Western medicine from 1st, Jan, 2019 to 31st, Dec, 2019 in Public Health Center. 50 patients' medical records were included. Results : Total number of treatment is 3,808 cases and 1.3% of them is prescribed Korean medicine and Western medicine simultaneously. Prescription of Korean medicine is 153 cases and Western medicine is 160. Jowiseunggi-tang and Diroba tablet were the most frequently prescribed Korean medicine and Western medicine. Furthermore, Korean Medicine Doctors of Public Health Center use muscular skeletal disease system code(M code among KCD code) for prescription and Western Medicine Doctors use diseases of the circulatory system(I code among KCD code) frequently. Conclusions : We analyze 50 patients who were prescribed both Korean medicine and Western medicine. Mostly, patients were prescribed medicine for different diseases in each clinic. In western medicine clinic, drugs about circulatory or endocrine disease were prescribed frequently and in Korean Medicine clinic, drugs about muscular skeletal disease were most frequently prescribed. This result imply the real world's combination of prescription status that was different from result of National health insurance corporation database. Senior patients in rural area take medicine long period and have various underlying disease. We call for some attention about senior and rural area patients' prescription status in interaction studies of Korean medicine and Western medicine.

• The Korean Journal of Applied Statistics
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• v.31 no.1
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• pp.77-96
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• 2018

A reverse mortgage provides a pension until the death for the insured or last survivor. Long-term risk management is important to estimate the contractual period of a reverse mortgage. It is also necessary to study prediction methods of mortality rates that appropriately reflect the improvement trend of the mortality rate since the extension of the life expectancy, which is the main cause of aging, can have a serious impact on the pension financial soundness. In this study, the Lee-Carter (LC) model reflects the improvement in mortality rates; in addition, multiple life model are also applied to a reverse mortgage. The mortality prediction method by the traditional LC model has shown a dramatic improvement in the mortality rate; therefore, this study suggests mortality projection based on the projection of the skewness for the mortality that has been applied to appropriately reflect the improvement trend of the mortality rate. This paper calculates monthly payments using future mortality rates based on the projection of the skewness of the mortality. As a result, the mortality rates based on this method less reflect the mortality improvement effect than the mortality rates based on a traditional LC model and a larger pension amount is calculated. In conclusion, this method is useful to forecast future mortality trend results in a significant reduction of longevity risk. It can also be used as a risk management method to pay appropriate monthly payments and prevent insufficient payment due to overpayment by the issuing institution and the guarantee institution of the reverse mortgage.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.11 no.6
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• pp.2169-2177
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• 2010

The effects of job related factors on psychosocial health status were examined by taking job stress into account. The self-administered questionnaires were performed, during the period between Oct. 1st, 2009 and Nov. 30th, 2009, to 805 individuals in the service of general administration located in Daejeon City. Causal relationships between job related factors, job stress, and, psychosocial health status were examined by structural equation model. The main finding as follows: For correlations of such indices of psychosocial health status as PWI and MFS with various studied items, all of these two indices were found to be in a negative correlation with the job position, job career, satisfaction in job life, autonomy of job, supervisors support and coworkers support, whereas in positive correlation with the experience of sick absence per year and job demand. With the analysis of structural equation model, the degree of job stress factors was more influential on the level of psychosocial health status than job related factors in such a manner as that the greater the job stress, while the lower the job related factors, the higher the psychosocial health status(PWI and MFS). Moreover, it was found to have the inter-relational effects that the greater the job related factors, the lower the job stress factors. Thus the effective strategy for stress and fatigue symptoms reduction among governmental employees requires additional programs focusing on innovated job specifications.

• Korean Journal of Social Welfare
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• v.59 no.3
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• pp.75-97
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• 2007

The purpose of this article is to explore French 'minima sociaux', focusing its scheme, benefit determination rule and its level appreciation. First, on the its structure domain, French 'minima sociaux' presents the plural system in which there is eight categorical benefits and one general benefit. Il is the representation of the intention to guarantee minimum income for the dead zone people out of the social insurance application and also a historical product in different period, by different logic of benefits implementation. Second, comparing nine benefits based on the benefit determination rule, level of benefits for the poor without work ability is higher than one for the poor with work ability. Il represents one polarized perception toward for the poor according to have or not its work ability. Third, comparing level of 'minima sociaux' with relative poverty line, the level of the most 'minima sociaux' is placed under the poverty line. Nevertheless, it must not forget that 'minima sociaux' plays its role as the fundamental alternative for poverty alleviation, but not the only alternative. Fourth and finally, comparing with minimum income guarantee(SMIC in french), level of RMI benefit is estimated merely on the 50% of SMIC. We can consider that it is the result of the interaction of the complex factors, as the limited role of the state toward the minimum income guarantee for the RMI beneficiary and the intervention the logic of status instead of the logic of need, etc..

• Journal of Gastric Cancer
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• v.7 no.4
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• pp.200-205
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• 2007

Purpose: The aim of this study was to analyze the post operative outcome of reconstruction with using the stomach after performing total pharyngolaryngoesophagectomy in patients with hypopharyngeal cancer or cervical esophageal cancer. Materials and Methods: We conducted a retrospective chart review of 23 patients who underwent gastric pull up for esophageal substitution at the Department of Surgery, Yonsei University College of Medicine, between January 1991 and December 2006. All the patients had transhiatal esophagectomy performed without thoracotomy. Results: There were seventeen males and six females with a median age of 58.1 years (range: 40-70 years). 19 cases were hypopharyngeal cancer, 13 cases had cancer in the pyriform sinus, 15 cases had cancer in the postcricoid area and one case had cancer in the glottic area. The rest were cervical esophageal cancers. The pathologic result was squamous cell carcinoma in all cases. The median total follow-up period was 33 months (range: 1-62 months) and there were two (8.6%) postoperative deaths: one was due to carotid rupture and the other was due to hepatic failure with liver metastasis. The complications were leakage in 1 patient (4.4%), pneumothorax in 1 patient (4.4%) and pneumonia in 1 patient (4.4%). Conclusion: The use of stomach for esophageal reconstruction has many benefits for treating hypopharyngeal cancer or cervical esophageal cancer, So, we made sure there was a sufficient length for the anastomosis after pharyngolaryngoesophagectomy and a rich blood supply from the stomach. There was a low incidence of the leakage at the anastomotic site, along with a low incidence of stenosis and bleeding.