• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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• pp.6919-6924
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• 2013

Background: Between 1998-2009 South Korea experienced significant progress in reducing the male smoking rate from 66.3% to 46.9%. As part of a significant government effort in the area of smoking cessation intervention, the Korean government implemented the national "Smoking Cessation Clinics (SCC)" program in 2004. Materials and Methods: Data covered 804,334 adult male smokers participating in SCC program at 253 public health centers between 2006-2009. We examined participant cessation rates with the SCC program, their characteristics and program intervention components using health insurance status as a socioeconomic status (SES) indicator. Multivariate logistic regression analyses were performed correcting for intra-class correlations within public health centers. Results: The overall 6-month quit rate was high (46.8%). Higher odds of smoking cessation were positively associated with higher levels of behavioral counseling sessions, but not nicotine replacement therapy (NRT). Cessation rates were lower for Medicaid participants than for regular health insurance participants. Disadvantaged younger smokers were less likely to participate in the program. Older smokers were more likely to quit regardless of SES. Stress was cited as major reason for failure. Conclusions: SES inequalities across different age groups exist in smoking cessation among Korean adult male smokers. There is a need for intervention programs specifically targeting sub-populations of SES by different age groups.

• Journal of Korean society of Dental Hygiene
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• v.16 no.2
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• pp.285-293
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• 2016

Objectives: The aim of the study was to investigate the association of self-perceived oral health and depression in the Korean elderly. Methods: The subjects were 1,329 elderly in Korea from the sixth Korea National Health and Nutrition Examination Survey (the 6th KNHANES). The dependent variable was depression that continued more than two weeks. Model I for the impacts of depression on self-reported oral health, Model II for the impacts of depression on chewing problem, Model III for the impacts of depression on speaking problem was evaluated. PASW Statistics 18.0 version was used for frequency analysis, chi-square test and logistic regression analysis. Results: Female elderly were much more prone to depression than male. Female had lower monthly compensation, less medicaid, chewing problem, speaking problem, and less education. For these reasons, they tended to have more depression than male (p<0.001). Self-perceived oral health impacts on depression included poor self-reported oral health(p<0.01), poor chewing problem(p<0.01) and poor speaking problem(p<0.05). On the other hand, male did not show a statistically significant association. Conclusions: The study showed the self-perceived oral health related quality of life had a significant influence on depression in the elderly. The continuing lifelong oral health care can prevent depression in the later life because oral health care improvement can enhance the self-perceived oral health status.

• Research in Community and Public Health Nursing
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• v.26 no.3
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• pp.278-291
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• 2015

Purpose: This study was conducted to examine differences in health care utilization and related costs between before and after the introduction of the designated doctor system, and to find out factors making the differences. Methods: Data were collected from 200 medical aid beneficiaries having one or more chronic diseases, registered in the designated doctor system during the year of 2012, and the relationship between the use of health services and claimed medical expenses was analyzed through paired t-test and multiple regression analysis using the SPSS 18.0 program. Results: There was a decrease in the number of total benefit days and the number of outpatient and medication days, but some cases showed an increase after the designation of medical institution. In general, hospital stay increased after the introduction of the system. However, the number of medical institutions utilized was reduced in most cases after designation. Conversely, medical expenses increased in most cases after the designation of medical institution. Conclusion: These results suggest that a detailed scheme to designate medical institutions should be made in consideration of the seriousness of illness and classification of medical institutions not only for the beneficiaries' enhanced health but for the effective management of medical aid fund.

• 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.

• Perspectives in Nursing Science
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• v.15 no.2
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• pp.81-91
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• 2018

Purpose: This study aimed to suggest strategies for advancing local-government-based accreditation systems and surveyor training in long-term care facilities in Korea. Methods: A comprehensive review of the literature including research papers and official reports issued by governments from the United States, Australia, and Japan was conducted to explore domestic and international policies related to long-term care facility certification and accreditation systems. Results: The USA has two types of care quality assurance systems including mandatory certification (5-star rating system) by the Centers for Medicare and Medicaid Services and voluntary accreditation by the Joint Commission on Accreditation of Healthcare Organizations. Australia operates a government-based mandatory accreditation system for all long-term care facilities through the Australian Aged Care Quality Agency. Japan, particularly the Tokyo district, operates a third-party evaluation system that involves the voluntary participation of long-term care facilities. Conclusion: This study provides several strategies to enhance accreditation processes and surveyors'expertise. For instance, motivating facilities to voluntarily participate in accreditation is necessary by 1) providing sufficient and continuous consultations and feedback about how to improve care quality, 2) differentiating accreditation domains and indicators from the national health insurance certification system, and 3) actively utilizing accreditation results and providing incentives.

• Research in Community and Public Health Nursing
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• v.12 no.1
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• pp.60-70
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• 2001

The purpose of this study was to analyze the relation between health behavior and public health center utilization among lower income families who earned half of the average Korean family income. The cross-sectional descriptive survey research we conducted was a nationwide randomization sampling among lower income families. The data was collected from July 12 to August 7. 1999 and the total sample was 5.819 household members 1,735 households). There were, three major findings according to these studies. 1. In health behaviors, 26.5% of respondents had a health examination. Among them, 41.5% were in a poor condition of health. In health promotion behaviors, only 37.3% of respondents were doing activities for health maintenance or promotion. 2. In the results of the public health center utilization for the past year. 57.4% of respondents visited one or more times. In addition, 46.2% of respondents wanted to use a visiting nursing service. 3. In the results of multiple logistic regression, we found that less education, larger family size, and medicaid affects more utilization of public health center. In addition, older age, living without a spouse, less education, larger family size, lower family income. and public health center usage affects requests for the visiting nurse service.

• 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.25 no.3
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• pp.197-206
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• 2015

Background: The purpose of this study was to propose a method for developing a measure of hospital-wide all-cause risk-standardized readmissions using administrative claims data in Korea and to discuss further considerations in the refinement and implementation of the readmission measure. Methods: By adapting the methodology of the United States Center for Medicare & Medicaid Services for creating a 30-day readmission measure, we developed a 6-step approach for generating a comparable measure using Korean datasets. Using the 2010 Korean National Health Insurance (NHI) claims data as the development dataset, hierarchical regression models were fitted to calculate a hospital-wide all-cause risk-standardized readmission measure. Six regression models were fitted to calculate the readmission rates of six clinical condition groups, respectively and a single, weighted, overall readmission rate was calculated from the readmission rates of these subgroups. Lastly, the case mix differences among hospitals were risk-adjusted using patient-level comorbidity variables. The model was validated using the 2009 NHI claims data as the validation dataset. Results: The unadjusted, hospital-wide all-cause readmission rate was 13.37%, and the adjusted risk-standardized rate was 10.90%, varying by hospital type. The highest risk-standardized readmission rate was in hospitals (11.43%), followed by general hospitals (9.40%) and tertiary hospitals (7.04%). Conclusion: The newly developed, hospital-wide all-cause readmission measure can be used in quality and performance evaluations of hospitals in Korea. Needed are further methodological refinements of the readmission measures and also strategies to implement the measure as a hospital performance indicator.