• Health Policy and Management
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• v.30 no.1
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• pp.37-49
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• 2020

Background: Unmet healthcare needs have many advantages for measuring inequalities in healthcare use. However, the existing indicator is difficult to capture the reality of unmet healthcare needs sufficiently and is not quite appropriate in comparing regional inequality. The purpose of this study is to critically analyze the utilization of the unmet healthcare need indicator for regional healthcare inequalities research. Methods: We used the level of healthcare accessibility and healthcare need to categorize the regions that are known to cause differences in healthcare utilization between regions and verified how existing unmet healthcare need indicator is distributed at the regional level. Results: Four types of regions were classified according to the high and low levels of healthcare needs and accessibility. The hypothesis about the regional type expected to have the highest unmet healthcare need was not proved. The hypothesis about the lowest expected regional type was proved, but the difference in the average rate of unmet healthcare needs among regional types was not significant. The standard deviation of the rate of unmet healthcare needs among regions within the same type was also higher than the overall regional variation, which also disproved the whole frame of hypothesis. Conclusion: Failure to prove the hypothesis means the gap between the supposed meaning of the indicator and the reality. In order to understand the current state of healthcare utilization of people in various regions of Korea and to resolve inequality, fundamental research on the in-depth structure and mechanisms of healthcare utilization is needed.

• International journal of advanced smart convergence
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• v.10 no.2
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• pp.168-174
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• 2021

Korea is ranked as the world's No. 1 country in its aging rate. While the interest and demand for health is rapidly increasing, the health status of the elderly is in the lowest among OECD members. Increased chronic diseases, the burden of medical costs and digital/untact changes of societies after COVID-19 have caused the direction of healthcare to be changed from treatment oriented to health care and prevention oriented, along with increased income levels and a desire for a healthy life. Amid this paradigm of change, the gap in health standards and health inequality for the elderly according to local structure and social conditions affects not only socio-economic but also the quality of life for individual senior citizen. Utilizing prior data of Aging Research Panel Survey, this study aims to compare and analyze health conditions and regional gaps which are significant influences on the satisfaction of the life of the elderly, and to suggest direction of studies for health care to provide solutions for health inequalities. The findings are intended to be a basic data for researching models of the New Normal Smart Healthcare System that bridge the health gap between the elderly and enhance life satisfaction with health care models suitable for regional characteristics in aging society.

• Health Policy and Management
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• v.28 no.3
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• pp.240-250
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• 2018

By the end of 2017, in a world of 7.6 billion people, there were inequalities in healthcare indices both within and between nations, and this gap continues to increase. Therefore, this study aims to understand the current status of regional inequalities in healthcare indices and to find an action plan to tackle regional health inequality through a geo-economic review in Korea. Since 2008, there was great inequality in life expectancy and healthy life expectancy by region in not only metropolitan cities but also districts in Korea. While the community health statistics from 2008-2017 show a continuous increase of inequality during the last 10 years in most healthcare indices related to noncommunicable diseases (except for some, like smoking), the inequality has doubled in 254 districts. Furthermore, health inequality intensified as the gap between urban (metropolitan cities) and rural regions (counties) for rates of obesity (self-reported), sufficient walking practices, and healthy lifestyle practices increased from twofold to fivefold. However, regionalism and uneven development are natural consequences of the spatial perspective caused by state-lead developmentalism as Korea has fixed the accumulation strategy as its model for growth with the background of export-led industrialization in the 1960s and heavy and chemical industrialization in the 1970s, although the Constitution of the Republic of Korea recognizes the legal value of balanced development within the regions by specifying "the balanced development of the state" or "ensuring the balanced development of all regions." In addition, the danger of a 30% decline or extinction of local government nationwide is expected by 2040 as we face not only a decline in general and ageing populations but also the era of the demographic cliff. Thus, the government should continuously operate the "Special Committee on Regional Balanced Development" with a government-wide effort until 2030 to prevent disparities in the health conditions of local residents, which is the responsibility of the nation in terms of strengthening governance. To address the regional inequalities of rural and urban regions, it is necessary to re-adjust the basic subsidy and cost-sharing rates with local governments of current national subsidies based mainly on population scale, financial independence of local government, or distribution of healthcare resources and healthcare indices (showing high inequalities) overall.

• The Journal of Korean Medicine
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• v.45 no.3
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• pp.168-180
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• 2024

Objectives: This study aims to understand the current state of regional healthcare services and explore the role of public health doctors of Korean medicine (PHDKMs) in addressing healthcare disparities. Methods: An online survey was conducted among 951 PHDKMs registered with the Korean Public Health Korean Medicine Doctors Association from July 15 to July 19, 2024. A total of 266 responses were collected, and after removing 2 insincere responses, 264 responses were used for analysis. The survey included questions on the provision of healthcare services and the role of PHDKMs in local healthcare crisis. Results: Out of 264 responses, 85 community health centers and branches (32.2%) lacked public health doctors (PHDs). The traveling clinics were the most common alternative in these cases. Centers without PHDs received 46 complaints (54.1%) about healthcare gaps, while centers with PHDs received 70 complaints (39.1%), showing statistically significant differences. The most common complaints involved consultation and management of chronic elderly diseases. PHDKMs reported being capable of providing musculoskeletal and internal medicine treatments, but identified a need for improvement in emergency response, basic and inflammatory treatments, consultation and management of chronic elderly diseases, administration of medications, and vaccinations. They expressed a high willingness and perceived capability to perform minor medical tasks. Conclusion: The decline in PHDs is adversely affecting regional healthcare. PHDKMs can help address these gaps through expanded roles and additional training. Policymakers should consider better integrating PHDKMs into the public healthcare system to ensure continuous and comprehensive healthcare services in underserved areas.

• KDI Journal of Economic Policy
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• v.29 no.1
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• pp.41-78
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• 2007

Due to the concern of regional unbalance relating to healthcare resources, the government has set up a plan to expand public healthcare services and a policy to manage the supply of hospital beds. However, it is not clear what standards are needed to measure the degree of unbalance, and to what extent the gap needs to be narrowed. Unlike the previous methodology comparing the proportions of patients who move out from their administrative district to receive medical services, this study examines the inconvenience gap patients experience when they have to move out from their actual living area. The logit and multinomial logit models are employed. The regional unbalance decreases when the degree of movement is measured based on the living area. This result implies that essential standard for achieving regional balance relating to medical services need to be based not on the even distribution of medical resources, but the complications of regional people that require proper medical services.

• Journal of Service Research and Studies
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• v.13 no.4
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• pp.113-130
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• 2023

This study is a single case study of the application of service design in a regional emergency medical centre of a senior general hospital, focusing on the experiences of patients and medical staff. It aims to measure and improve the experience of healthcare services using service design techniques and to verify their effectiveness. A qualitative case study centred on ethnography and design workshops was conducted to collect in-depth experience data from patients and medical staff. The study identified key experiential differences between patients and healthcare workers, with a particular focus on the challenges faced in emergency medical services. The qualitative data collected through patient and healthcare worker interviews and design thinking workshops were analysed and incorporated into the design in order to understand the complex dynamics of the regional emergency medical centre environment. The results of the study highlighted the need to improve communication, manage patient flow, and improve the environment in three main aspects of the current state of design reflecting the needs of patients and medical staff. By analysing the differences in the specific needs of the two groups of patients and medical staff, a design-led implementation process can be applied to improve the services of the regional emergency medical centre. This study highlights the role and importance of design in healthcare and provides an efficient way to bridge the gap between theoretical research and practical design implementation. This will contribute to creating a faster, more effective, and more satisfying healthcare experience. It is hoped that this will be a new opportunity to see service design as a key to a new innovation process for the satisfaction of both patients and medical staff.

• Health Policy and Management
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• v.33 no.1
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• pp.40-54
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• 2023

Background: Based on the increase in the needs for convalescent rehabilitation medical services in Korea, this study aims to calculate the needs for rehabilitation services and examine its determinants for 229 regions. Methods: Claim data from the Health Insurance Review and Assessment Service were used to estimate patients who need to receive rehabilitation services, and data from various sources were also used for analysis. The number of cases and incidence rates of hospitalization related to convalescent rehabilitation were calculated to estimate the needs for services by region, and the results were visualized via a map. Multivariate regression and fixed effects regression using panel data were performed to identify the determinants of regional variation of the incidence rate. Results: First, the incidence rate of rural areas such as Jeolla-do, Gyeongsang-do, and Chungcheong-do was higher than urban areas (metropolitan cities). Second, the population, proportion of the elder, medical aid recipients, financial independence, traffic deaths, smoking, diabetes rate, and medical infrastructure correlated significantly with the incidence rate. Third, 'rho' values which mean the fraction of variance due to individual terms in panel data regression models were 0.965 and 0.976, respectively. Conclusion: The incidence rate of hospitalizations was correlated with most independent variables in this study and there is a gap between urban and rural areas. These regional disparities are fixed in our society. An improved regional convalescent rehabilitation system is suggested to cover the entire area including rural areas with a high rate of aging.

• Korean Journal of Community Nutrition
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• v.28 no.2
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• pp.95-103
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• 2023

Objectives: The budget gap in the health sector of local governments affects the supply of health services, which can cause the health gap. This study classified local governments according to their financial characteristics, such as local financial independence and health budget level. It analyzed the health behaviors and disease prevalence of local residents to examine the effect of local government financial investment on the health of local residents. Methods: To classify types according to the financial characteristics of local governments, financial independence and the health budget data for 17 local governments were collected from the local fiscal yearbook of the Ministry of Public Administration and Security. The prevalence of chronic diseases and healthy behavior was compared using the 16,333 data of adults between the ages of 30 and 65 years among the original data of the National Health and Nutrition Examination Survey (2016-2020). Results: Cluster analysis was used to classify local governments into five clusters according to the health financial capacity type. A comparison of the prevalence of local residents by cluster revealed a similar prevalence of hypertension, diabetes, and hypercholesterolemia. On the other hand, the obesity rate (P < 0.01), high-risk drinking rate (P < 0.01), aerobic physical activity rate (P < 0.001), and healthy eating practice rate (P < 0.001) were significantly different. In addition, an analysis of the odds ratio based on the Seoul area revealed a higher risk of health behavior of non-Seoul residents. Conclusions: It is necessary to review the universal health promotion project budget considering the degree of regional financial vulnerability from the viewpoint of health equity to narrow the health gap among regions.

• Health Policy and Management
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• v.31 no.1
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• pp.65-73
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• 2021

Background: With the recent aging of the population, the transition to a disease structure centered on chronic diseases is accelerating. Moreover, the socio-economic gap and the polarization of the health gap between regions further increase the burden of disease on the country. Accordingly, this study calculated the disease cost of hypertension, diabetes, and hyperlipidemia, which are the three major chronic diseases, to establish an effective health promotion policy strategy for each region, and analyzed the gap in disease cost within the region to determine health determinants at the individual as well as the regional level. Methods: This study utilized data from the 2015 sample cohort of the National Health Insurance Service and calculated the disease cost of patients (diabetes: I10-I15, hypertension: E10-E14, hyperlipidemia: E78) based on the main diagnosis. Results: Based on our analysis, the case of medical use in cities and provinces was higher than in metropolitan cities, with relatively small medical use in Seoul and Gangwon-do. In terms of the disease cost, the cost of chronic diseases in Seoul and Jeju was the highest, but the difference in disease cost between patients in each region was the largest in Seoul and Gangwon-do. Conclusion: The results of this study provide meaningful data for implementing efficient health promotion policies by analyzing the differences in disease cost and identifying health determinants in different regions. Furthermore, in Korea, where socioeconomic differences are clearly revealed, it can be used as a basis for preparing a strategic plan, from a long-term perspective, to improve the health of patients with chronic diseases in the future.

• The Korean Journal of Health Service Management
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• v.7 no.3
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• pp.95-109
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• 2013

The objective of this study is to assess the utilization and satisfactions about public health centers in Korea. For the analysis, the study utilize the nationwide data of 229,229 person on '2010 Community Health Survey' of Ministry of Health & Welfare. The statistical methodology used in the study is ${\chi}^2$, ANOVA, logistic regression model and multiple regression model. This study have four major findings. First, the significant affecting socio-demographic factors in utilizing public health center were gender, age, region, national basic living secured, married, income, education, job, state of health, chronic disease, unmet medical needs and utilization reason. Second, the most serviced category of health center user was vaccination both city and rural area and the next was certificate, primary care, health screening, other use, the mother and child in city area, primary care, health screening, certificate, home visiting health in rural area. Third, the significant affecting socio-demographic factors in satisfaction degree on health center service were age, region, national basic living secured, income, education, job, state of health, utilization degree and reason. Fourth, the most satisfied service of health service center was home visiting health in city area and mental health service in rural area and the next was nutritive control and the lowest satisfied service was user of certificate. The utilization and satisfaction on health center service were identified as different with residental area and user's characteristics. The politic effort are needed to support socially disadvantaged class and to narrow regional gap.