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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
Editor in Chief :
Volume & Issues
Volume 19, Issue 4 - Dec 2009
Volume 19, Issue 3 - Sep 2009
Volume 19, Issue 2 - Jun 2009
Volume 19, Issue 1 - Mar 2009
Selecting the target year
Factors Affecting Health of the Rural Residents
Son, Dong-Koog ; Lee, Kyu-Sik ; Park, Jong-Ku ; Koh, Sang-Baek ; Jin, Ki-Nam ; Nam, Eun-Woo ; Lee, Hae-Jong ;
Health Policy and Management, volume 19, issue 4, 2009, Pages 1~17
DOI : 10.4332/KJHPA.2009.19.4.001
The purpose of this study was to find factors affecting health of the rural residents. The data were collected from a sample of 2,587 people aged from 40 to 70 in the year 2005-2006, Wonju City and Pyeongchang County, Gangwon-do, Korea. The theoretical model adopted in this study was the Lalonde's health field(human biology, environment, lifestyle, and health care organization). SF-12 was used to measure subjective health status. In the category of human biology, men were healthier than women. Age and BMI showed negative relation to health status. Income, education and social support showed positive relation to health status in the environment category. In the category of life style, stress showed negative relation to health status. Medical expenses showed negative relation to health status in the category of health care organization. After converting SF-12 score to percentage score, the health determinants portions were 47% lifestyle, 26% environment, 18% human biology and 9% health care organization. These findings suggest that life style, environment and biology are main factors in determinants of health. Especially stress in the life style category is more focused for the community health promotion. We also may be able to improve income, education and social support in the environment category with self empowerment efforts, community supports and government helps. Finally greater attention must be payed to life style in the future health planning and budget allocation priority in the healthcare area.
Health Outcome Prediction Using the Charlson Comorbidity Index In Lung Cancer Patients
Kim, Se-Won ; Yoon, Seok-Jun ; Kyung, Min-Ho ; Yun, Young-Ho ; Kim, Young-Ae ; Kim, Eun-Jung ; Kim, Kyeong-Uoon ;
Health Policy and Management, volume 19, issue 4, 2009, Pages 18~32
DOI : 10.4332/KJHPA.2009.19.4.018
The goal of this study was to predict the health outcomes of lung cancer surgery based on the Charlson comorbidity index (CCI). An attempt was likewise made to assess the prognostic value of such data for predicting mortality, survival rate, and length of hospital stay. A medical-record review of 389 patients with non-small-cell lung cancer was performed. To evaluate the agreement, the kappa coefficient was tested. Logistic-regression analysis was also conducted within two years after the surgery to determine the association of CCI with death. Survival and multiple-regression analyses were used to evaluate the relationship between CCI and the hospital care outcomes within two-year survival after lung cancer surgery and the length of hospital stay. The results of the study showed that CCI is a valid prognostic indicator of two-year mortality and length of hospital stay, and that it shows the health outcomes, such as death, survival rate, and length of hospital stay, after the surgery, thus enabling the development and application of the methodology using a systematic and objective scale for the results.
Analysis of Health Promotion determinants in Major OECD Countries: A pooled cross-sectional time series
Choi, Yoon-Jung ; Bae, Sung-Il ; Lee, Young-Ho ; Kang, Min-Sun ;
Health Policy and Management, volume 19, issue 4, 2009, Pages 33~52
DOI : 10.4332/KJHPA.2009.19.4.033
Health promotion policies have needed to assess in detailed and evidence-based work to set a policy goal and clear future directions of health promotion in Korea. To identify the major factors related with health promotion, we assessed the associations between public health outcome (potential years of life loss, PYLL) and national health determinants. For this purpose, we used a pooled cross sectional time-series regression analysis with corrected fixed effect models involving sixteen member countries of the Organisation for Economic Cooperation and Development during the period 1970 to 2001. The PYLL was positively associated with tobacco and alcohol consumption (model 1 and 2) and calories intake (model 2 and 3) while the PYLL was negatively associated with GDP, fruit and vegetable intake (model 2), number of doctors (model 3), coverage rates of health care security, and elderly population rates (model 4). In conclusion, health behaviors related with tobacco, alcohol, and nutrition were significant health determinants for health outcome. Overall analysis results of this study will provide a guidance toward improved macro- and micro-policy development for future health promotion policy in Korea.
Prenatal care utilization and expenditure among pregnant women
Kim, Kyung-Ha ; Hwang, Rah-Il ; Yoon, Ji-Won ; Kim, Jin-Soo ;
Health Policy and Management, volume 19, issue 4, 2009, Pages 53~65
DOI : 10.4332/KJHPA.2009.19.4.053
Purpose: This study was conducted to identify the prenatal heath care utilization and expenditure among pregnant women. Method: This was a 5-month follow-up study using a stratified sampling and the data were drawn from the "nationwide claim database of Korean National Health Insurance Corporation". Result: This study found that pregnant women were first diagnosed with pregnancy when they were 7.1 weeks pregnant, received 12.7 times of prenatal examinations and 10.6 times of ultrasonogram. It was revealed that 67.5% of the subjects continued to receive prenatal care at the same medical institutions from the diagnosis of pregnancy to the delivery. The study also showed that the total expenditure of prenatal care per pregnant woman was 700,000 Korean Won (KRW) on average and the insurance coverage rate stood at only 20%. Pregnant women living in metropolitan area spent more on prenatal healthcare expenditure than those who living in medium-sized city or rural area. Conclusion: The results of this study implies that the government needs to provide pregnant women with continuous support by increasing health insurance coverage for prenatal care. Especially, it is considered to provide more support to the pregnant women residing in medically underserved areas.
Effect of Socioeconomic Status on Healthcare Utilization in Patients with Rare and Incurable Diseases
Im, Jun ; Kim, Myeong-Hee ; Im, Jeong-Soo ; Oh, Dae-Gyu ;
Health Policy and Management, volume 19, issue 4, 2009, Pages 66~77
DOI : 10.4332/KJHPA.2009.19.4.066
This study aims to examine the effect of socioeconomic status (hereafter, SES) on healthcare utilization of the patients with rare and incurable diseases. Information of 2,973 patients who were self-employed insured and utilized healthcare service in 2007 was drawn from the National Health Insurance (hereafter, NHI) claim data. SES was set as four groups based on the monthly contribution. Outcome variable was the expense for outpatient and in-hospital services, which was log-transformed and square-rooted in oder to obtain normal distribution. Covariates included age, gender, residence and diagnosis. To examine the effects after controlling for covariates, we employed generalized estimating equation model, since patients with the same diagnosis are likely to have similar characteristics of demographics and healthcare utilization. Univariate statistics showed that lower SES was associated with less utilization of healthcare services. After controlling for covariates, a significantly smaller amount of money was expended for the lowest SES group compared to the highest one. Rural residence was associated with less utilization, except that residents in Seoul significantly more utilized outpatient services in tertiary hospitals. Considering that there is a subsidy program for the low income patients, such differences in healthcare utilization according to SES seems to result from the burden of out-of-pocket payments for uncovered services of the NHI.
Factors related to Family Caregiver Satisfaction with the Institutional care services under the Public Long-Term Care Insurance system
Kwon, Jin-Hee ; Han, Eun-Jeong ; Lee, Jung-Suk ;
Health Policy and Management, volume 19, issue 4, 2009, Pages 78~97
DOI : 10.4332/KJHPA.2009.19.4.078
This study examined the factors related to family caregiver satisfaction with institutional care services for beneficiaries under the Public Long-Term Care Insurance(PLTCI) system. Determining what contributes to family caregiver satisfaction is a critical step toward implementing effective quality improvement strategies. A national cross-sectional descriptive survey was conducted from November to December 2008, using proportionate quota sampling based on the location and level of Long-Term Care of the beneficiaries. Total 1,745 family caregivers wrote informed consents and 733 (response rate 42%) completed questionnaires, which included caregiver characteristics, organizational resources, primary objective and subjective stressors, perceived quality of services, and family caregiver satisfaction. Family caregivers were satisfied overall with institutional care. In multiple regression analysis, there was a statistically significant difference in degree of family caregiver satisfaction according to caregiver characteristics(relationship to beneficiary), primary objective stressors (insurance type of beneficiary), perceived quality of services(respect to family caregivers' idea, ADL support, expertness of staff, careful concern of staff, fulfillment of client's requests, and safety of institution's environment). In public long-term care, satisfaction efforts are in an early stage of development. This study is meaningful as the first attempt to measure family caregiver satisfaction with institutional care for beneficiaries under the PLTCI system, and to identify factors affecting the satisfaction. Among the identified factors, the policy makers, the insurer, and the providers need to pay attention to perceived quality of services, in particular, to improve customer satisfaction. Our findings can provide quality care improvement initiatives in the public long-term care setting.
Eliciting stated preferences for drugs reimbursement decision criteria in South Korea
Lim, Min-Kyoung ; Bae, Eun-Young ;
Health Policy and Management, volume 19, issue 4, 2009, Pages 98~120
DOI : 10.4332/KJHPA.2009.19.4.098
The purpose of this study is to elicit preference for drug listing decision criteria and to estimate the ICER threshold in South Korea using the discrete choice experiment (DCE) method. To collect the data, a DCE survey was administered to a subject sample either educated in the principle concepts of pharmacoeconomics or were decision makers within that field. Subjects chose between alternative drug profiles differing in four attributes: ICER, uncertainty, budget impact and severity of disease. The orthogonal and balanced designs were determined through computer algorithm to take the optimal set of drug profiles. The survey employed 15 hypothetical choice sets. A random effect probit model was used to analyze the relative importance of attributes and the probabilities of a recommendation response. Parameter estimates from the models indicated that three attributes (ICER, Impact, Severity of disease) influenced respondents' choice significantly(p
0.001). In addition, each parameter displayed an expected sign. The Lower the ICER, the higher the probability of choosing that alternative. Respondents also preferred low levels of uncertainty and smaller impact on health service budget. They were also more likely to choose drugs for serious diseases rather than mild or moderate ones. Uncertainty however is not statistically significant. The ICER threshold, at which the probability of a recommendation was 0.5, was 29,000,000 KW/QALY in expert group and 46,500,000 KW/QALY in industry group. We also found that those in our sample were willing to accept high ICER to get medication for severe diseases. This study demonstrates that the cost-effectiveness, budget impact and severity of disease are the main reimbursement decision criteria in South Korea, and that DCE can be a useful tool in analyzing the decision making process where a variety of factors are considered and prioritized.
Regional Commitment Index of Hospitals
Kim, kyung-Ae ; Ryu, See-Won ; Kim, Young-Rhang ;
Health Policy and Management, volume 19, issue 4, 2009, Pages 121~139
DOI : 10.4332/KJHPA.2009.19.4.121
Objectives : The purpose of this study was to investigate regional commitment index(RGI) of hospital in Korea, and the relationship RGI and hospital characteristics, such as foundation, region, size. Therefore, we are to suggest fundamental information to make and evaluate healthcare resource policy in hospital- and government-level. Methods : The 'Patient Survey 2002(administered by Ministry of Health and Social Welfare(MOHW)' was analyzed. We selected the patient data of the hospitals above 100 beds. Then, we calculated the RGI, number of same cases divided by all cases in each hospital. By using SPSS/win ver 14.0, statistical analysis such as t-test, ANOVA, correlational and regression analysis was carried out. Results : The results are as follows. 1. Overall mean and standard deviation of RGI were revealed as 0.805
0.225 in inpatients, and 0.871
0.184 in outpatient. The median of inpatients' and outpatients' RGI were 0.890 and 0.933. The RGI of inpatients of private hospitals were revealed significantly higher than that of the public(public: 0.727, private: 0.822). However, outpatients' RGI was not revealed as significantly different. 2. The RGI of general specialty hospitals were significantly lower than others, therefore we could think that more inpatients and outpatients of general specialty hospitals flowed in from others province or metropolitan cities than other hospital types. 3. The RGI of hospitals holding above 400 beds were significantly lower than others in inpatients and outpatients. 5. The RGI of hospitals were significantly different among sixteen province and metropolitan cities. The RGI inpatients of Gwangju and Daejon metropolitan city were lowest sub-group(0.659, 0.664), and the RGI inpatients of Jeju was revealed as highest, 0.979. 6. Available beds, total doctors, and total employees were negatively correlated with RGI of inpatients and outpatients. 7. The significant influencing factors to RGI of inpatients and outpatients were appeared samely such as available beds, wide healthcare region, hospital size, and foundation type. Conclusions : It is considered that RGI of hospital represent competitive power in healthcare market. Also, the competitive advantage and quality of hospital clustered by characteristics could made out by RGI. Therefore, the results of this study would be useful to develop and evaluate hospital policy of individual hospital or local government.