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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Health Policy and Management
Journal Basic Information
Journal DOI :
The Korean Society of Health Policy and Administration
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Volume & Issues
Volume 18, Issue 4 - Dec 2008
Volume 18, Issue 3 - Sep 2008
Volume 18, Issue 2 - Jun 2008
Volume 18, Issue 1 - Mar 2008
Selecting the target year
Differences in the burden of disease of the elderly by socioeconomic status
Lee, Chae-Eun ; Kwon, Soon-Man ;
Health Policy and Management, volume 18, issue 4, 2008, Pages 1~22
DOI : 10.4332/KJHPA.2008.18.4.001
Burden of disease analysis provides a unique perspective on health by integrating fatal and non-fatal outcomes, yet allows the outcome of two classes to be examined separately. Although many studies have shown the inequality in health outcomes across socioeconomic status (SES), an analysis and comparison of Disability Adjusted Life Year (DALY) between different socioeconomic groups has been rare. This paper calculates the DALY and analyzes the distribution of DALYs for different SES. This study draws from 3,278 cases from the survey on "The Livelihood and Welfare Needs of the Elderly (2004)". It first provides a comprehensive assessment of the burden of 10 chronic diseases of the elderly based on DALY. Then this paper analyzes inequalities in the burden of disease by the levels of SES such as education, income, family size, occupation, and subjective economic conditions. For the elderly, the burden of disease is the highest for hypertension, arthritis and cancer. DALY rate per 1,000 people for the most socio-economically disadvantaged group is expressed as a multiple of the standardized rate for the least disadvantaged group (Rate Ratios). Family size is strongly related to. the difference in the burden of disease between SES groups, and the elderly Who live alone have higher DALY rate than those who live with their family. Other significant variables related to SES groups include subjective economic conditions, occupation, elderly income, and household income.
Changes in financial burden of health expenditures by income level
Kim, Tae-Il ; Huh, Soon-Im ;
Health Policy and Management, volume 18, issue 4, 2008, Pages 23~48
DOI : 10.4332/KJHPA.2008.18.4.023
Although the universal health insurance, National Health Insurance (NHI), have improved access to health care and financial burden of health care costs for Koreans, limited coverage of the NHI leads to high out-of-pocket payment for health care. This study examines financial burden of household health expenditures by income level. Data from the Urban Household Expenditure Survey from 1985 through 2005 is analyzed and household expenditure is used as a proxy measure for income. Health expenditures include spending for inpatient care, ambulatory care and pharmaceuticals. If a household spends health expenditure above 40% of household consumption except for foods, that is defined as catastrophic health expenditure. Access to health care for the lowest income group had been improved for two decades relative to other income groups as well as in absolute term. However, both financial burden of health expenditures and the proportion of households that experienced catastrophic health expenditure had been increased in the lowest income group. Study findings have several policy implications. First, in terms of financial burden of health expenditures. the differences among income groups decreased until 2000 but it was worsen in 2005. This suggests that recent policies for extending NHI coverage are not enough to improve the disparity by income level. Second, a differential catastrophic coverage by income level would be an effective strategy that relieves financial burden for low income group. Third, since the catastrophic coverage is applied to only covered services by the NHI, additional strategy for uncovered services should be considered.
The Difference of Mortality According to Self-Assessed Health Status
Woo, Hye-Kyung ; Moon, Ok-Ryun ;
Health Policy and Management, volume 18, issue 4, 2008, Pages 49~65
DOI : 10.4332/KJHPA.2008.18.4.049
The single-item question of self-assessed health status has consistently been reported to be associated with mortality in some developed countries, even after controlling for a wide range of health measurements and known risk factors for. mortality. It was intended in this study to find out whether or not such a relationship would also be valid in Korea. This study examined the effect of point of reference year on. the, predictive validity of self-assessed health for mortality in 6-year follow-up period. we need to test the validity of the self-assessed health, as an indicator for assessing health status using Cox's proportional hazard model. For the analysis, we used the data from the 2nd (1999) to the 7th survey of "Korean Labor and Income Panel Study," and assessed relative risk of death based on subjective health state by tracing 11,366 people who replied to the question of self-assessed health state in the 2nd year. According to the result, those who reported poor self assessed health state in the 2nd year showed a relatively high death rate, and their relative risk of death was significantly higher. Such a relationship was accentuated if the predictive value of the 2nd survey result would be replaced by the average of the cumulative data on the past six years. Thus, it can be concluded that self-assessed health state is valid as an index for assessing Korean people's health status.
Trends of Health Care Utilization and Relevance Index of Stroke Inpatients among The Self-Employed Insured and Their Dependents of National Health Insurance (1998-2005)
Kim, Ji-Hyun ; Cho, Byung-Mann ; Hwang, In-Kyung ; Son, Min-Jeong ; Yoon, Tae-Ho ;
Health Policy and Management, volume 18, issue 4, 2008, Pages 66~84
DOI : 10.4332/KJHPA.2008.18.4.066
Objectives: This study aimed to. offer some fundamental evidences for the stroke management policy by investigating the trends of medical care utilization and regionalization in stroke inpatients. Methods: We used the National Health Insurance claims and registry data for stroke inpatients from 1998 to 2005. Among all stroke inpatient claims data, self-employed insured and their dependents were only included in this study. The classification of stroke was based on ICD-10(I60-I69) and its subtype was divided by hemorrhage(I60-I62) and infarction(I63-I64) type. To evaluate regionalization of medical care utilization, relevance index was calculated by regions. The regions were classified 8 large catchment areas and 163 self authorized areas. Results: The overall medical care utilization rate of stroke inpatient has been increased, especially infarction subtype. Among medical care institutions, the utilization of hospital has been the most rapidly increased. Although considered annual rate of interest, total medical cost of stroke inpatients has been increased, Totally, more than 84% of stroke inpatient were admitted to medical care institutions in their own large catchment area during 1998-2005. The relevance indices in their own large catchment area (self sufficiency rates) were more than 70% in most areas regardless of stroke subtype except Chungbuk catchment area. Self sufficiency rates of stroke inpatients among 163 self authorized areas in 1998 and 2005 were 84.2% and 83.1% in metropolitan, 46.7% and 45.5% in urban, and 19.5% and 22.6% in rural areas, respectively. Conclusion: Stroke management policy for improvement of distribution at the district level, especially in rural areas, may be helpful for reducing regional inequality in stroke.
A Study on a Long-term Demand Forecasting and Characterization of Diffusion Process for Medical Equipments based on Diffusion Model
Hong, Jung-Sik ; Kim, Tae-Gu ; Lim, Dar-Oh ;
Health Policy and Management, volume 18, issue 4, 2008, Pages 85~110
DOI : 10.4332/KJHPA.2008.18.4.085
In this study, we explore the long-term demand forecasting of high-price medical equipments based on logistic and Bass diffusion model. We analyze the specific pattern of each equipment's diffusion curve by interpreting the parameter estimates of Bass diffusion model. Our findings are as follows. First, ultrasonic imaging system, CT are in the stage of maturity and so, the future demands of them are not too large. Second, medical image processing unit is between growth stage and maturity stage and so, the demand is expected to increase considerably for two or three years. Third, MRI is in the stage of take-off and Mammmography X-ray system is in the stage of maturity but, estimates of the potential number of adopters based on logistic model is considerably different to that based on Bass diffusion model. It means that additional data for these two equipments should be collected and analyzed to obtain the reliable estimates of their demands. Fourth, medical image processing unit have the largest q value. It means that the word-of-mouth effect is important in the diffusion of this equipment. Fifth, for MRI and Ultrasonic system, q/p values have the relatively large value. It means that collective power has an important role in adopting these two equipments.
A Case Study on the Shift System Change and Learning Organization Building in Healthcare Organizations
Kim, Kwang-Jum ;
Health Policy and Management, volume 18, issue 4, 2008, Pages 111~124
DOI : 10.4332/KJHPA.2008.18.4.111
New ways of work-shift and learning programs, which were based on the concept of 'performance improvement through people', have been introduced to healthcare organizations. I analyzed the performance of the changes and the performance differences. Data were collected through interview and survey. I discussed that modification of management practices which were developed in manufacturing organizations is important for successful implementation in healthcare organizations.
Factors affecting the collaboration between nurses in community health department and social workers in welfare services department
Kim, Mi-Ju ;
Health Policy and Management, volume 18, issue 4, 2008, Pages 125~147
DOI : 10.4332/KJHPA.2008.18.4.125
The purpose of this study is to propose the factors affecting collaboration between community nurses and social workers in Korea. Data that is used in this study, were collected from 295 provider respondents by questionnaire, additionally from telephone survey and secondary data review. This study focuses on the working relationship between professionals in the field of health and social care. Based on the literature review, this study proposes a conceptual framework for collaboration between nurses and social workers in community health and social care. The dependent variable in this study is collaboration. It reveals whether or not the inter-professional works and shows the level of collaboration. The independent variables are categorized in: the client characteristics (frailty of client, client-provider relationship); the provider characteristics (specialization, perception of interdependence, perception of the other professional); the organization characteristics (closeness of the other professional, autonomy, on-the-job training, evaluation-reward); and the community characteristics (urbanization, capacity of resources). Major findings are as follows: First, the factors that appear to have the strongest impact on whether or not inter-professional working of respondent sampled are: the perception of other professional; the perception of interdependence; closeness of, the, other professional; and the frailty of client. Secondly, the factors that found to have the most significant effect on level of cooperation are: the perception of, the other professional; on-the-job training; evaluation-reward; and the closeness of the other professional.
Health Services Utilization and Financial Performance of For-Profit versus Nonprofit Hospitals: A Study of General Acute Care Hospitals in the United States
Choi, Man-Kyu ; Lee, Keon-Hyung ; Lee, Bo-Hye ;
Health Policy and Management, volume 18, issue 4, 2008, Pages 148~169
DOI : 10.4332/KJHPA.2008.18.4.148
As the Korean Government began to perceive healthcare as one of foundational industries for national dynamics, there has been mounting advocacy for the introduction of for-profit hospitals with a view to bringing efficiency in healthcare services industries and improvement of their international competitiveness. The Government is now considering the issue from all angles in favor of permitting for-profit hospitals. However, There have been few precedent studies on this subject to provide helpful data for the discussion and in the health policy making. This study used private hospitals - for-profit and nonprofit - in Florida, USA as study subjects to accumulate basic data that may be utilized for those involved in debates and health policy making relating to the introduction of for-profit hospitals in Korea. Among all the private general hospitals in Florida, those surveyed by AHA(American Hospital Association) for four consecutive years from 2001 and 2004 and others reported about to MCR(Medicare Cost Report) included in the collected data for analysis. In total 139 private general hospitals consisting of 73 for-profit hospitals and 66 nonprofit hospitals were included in the collected analysis data. Results of analysis revealed no significant difference between for-profit hospitals and nonprofit hospitals in the usage aspects of healthcare services including the average length of stay and the ratio of Medicare vs Medicaid patients. However, financial performances indicated by such factors. as the pre-tax return on assets and the pre-tax operating margin showed to be significantly higher in for-profit hospitals compared with nonprofit hospitals. And the ratio of personnel expenses and the turn period of total assets showed to be significantly lower in for-profit hospitals. Based on the hypothesis that arguments about the introduction of for-profit hospitals have considerably different viewpoints depending on the size of hospital represented by the number of bed, these two hospital types were compared again using the number of beds as a controlled factor, but the results were similar. We, therefore, could conclude that the for-profit hospitals in Florida included in this study could, in their for-profit operation, improve their financial performance by pursuing cost reduction and effectively utilizing their assets without limiting the amount and the range of their services or avoiding less medically protected groups such as Medicare and Medicaid patients.
Factors associated with access to dental care among Korean adults
Noh, Hie-Jin ; Choi, Choong-Ho ; Sohn, Woo-Sung ;
Health Policy and Management, volume 18, issue 4, 2008, Pages 170~184
DOI : 10.4332/KJHPA.2008.18.4.170
Objectives: The aim of this analysis was to investigate factors associated with dental visits in terms of getting diagnosis and receiving care for diagnosed dental diseases among Korean adults. Methods: Data used in this analysis were from the 2005 Korean National Health and Nutrition Examination Survey which involved a representative sample of 25,487 adults nineteen years of age and older who resided in Korea. This analysis used data of adults who had completed health interview survey (n = 25,215). Uni- and bi-variate analysis, Chi-square test, and logistic regression analyses. were conducted using SAS. Results: The percentages of people diagnosed (treated) dental canes, periodontal disease. and temporomandibular joint disorder were 70.4(77.1), 16.1 (55.7), and 0.6(37.4), respectively. The reception of treatment for diagnosed dental caries and periodontal disease was significantly associated with older age, high monthly household income, and high education attainment. Logistic regression model indicated that age, monthly household income, education attainment, type of health insurance, and chewing problem were significantly associated with getting diagnosis and treatments of dental diseases. Most frequently answered reason for non - or delayed treatments of diagnosed dental diseases during the last one year was cost of treatments. Conclusions: The findings indicated that socio-economic-status still significantly affected reception of needed dental treatments among Korean adults despite the national health insurance system. Oral health policy and programs should be augmented to provide further support to adults of low socio-economic-status who are more prone to dental diseases yet lack resources for needed dental treatments.
How-to of MB Government's Health Care Policy: Private Health Insurance and For-Profit Hospitals
Kim, Won-Shik ;
Health Policy and Management, volume 18, issue 4, 2008, Pages 185~206
DOI : 10.4332/KJHPA.2008.18.4.185
The National Health Insurance (NHI) has been the main body of health care system in Korea for the last 30 years since the NHI was founded. However, the inefficient management and strong regulations of the NHI have hindered the development of health care industry. The establishment of the MB government, whose interest lies on economic growth rather than equity, is expected to help the health care services gain a momentum. The essential measures that can step up public health care services overall are the following: the introduction of competition within NHI, the activation of private health care insurance, and the allowance of for-profit hospital. The private-public mix with market mechanism would level up the health care service for the public.