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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Health Policy and Management
Journal Basic Information
Journal DOI :
The Korean Society of Health Policy and Administration
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Volume & Issues
Volume 23, Issue 4 - Dec 2013
Volume 23, Issue 3 - Sep 2013
Volume 23, Issue 2 - Jun 2013
Volume 23, Issue 1 - Mar 2013
Selecting the target year
Development and Reconsideration of Korea Healthcare System
Lee, Kyu Sik ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 303~313
DOI : 10.4332/KJHPA.2013.23.4.303
During last 65 years, Korea has achieved very rapid economic growth and social reformation including healthcare system. Many foreigners have praised that Korea healthcare system is very good in the respect of ease accessibility to healthcare under the lowest cost among the industrialized countries. Whole population are covered by the National Health Insurance. Also utilizations of healthcare among different income classes are even. However Korea healthcare system faced with several challenges, in terms of the an aging population and a rise in chronic disease problem, new threats of communicable disease due to globalization, the rapid increase of healthcare expenditure and high financial burden of patients even though they are insured. To cope with these challenges, we need reconsider the healthcare system as followings; to set up ideology of healthcare as normative public goods, to rebuild paradigm of healthcare for 21 century, to reform public health for strengthening health promotion, to develop new method for healthcare management including quality improvement and consumer responsiveness, to build new governance for health and to view new perspective on healthcare as a kind of industry.
Comparative Analysis of Stem Cell Research Policy Changes in UK, US, and South Korea: Application of Advocacy Coalition Framework Model
Bae, Green ; Kang, Minah ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 314~325
DOI : 10.4332/KJHPA.2013.23.4.314
Background: Stem cell research competition is accelerating globally since President Obama signed an executive order, repealing Bush-era policy that limited use of federal tax dollars for embryonic stem cell research. Methods: In this paper, we conducted a comparative analysis of stem cell research policy changes in three countries, including the Human Fertilisation Embryology Act (HFEA) of UK, executive order 13,505 (removing barriers to responsible scientific research involving human stem cells) of USA, and Bioethics and Safety Act of South Korea. Debates on stem cell research are based on conflicts of fundamental beliefs that exist in the supporting and opposing coalitions. We compared regional characteristics of the advocacy coalitions in three countries and presented various factors that might be related to the policy changes. Results: The UK government, parliament, and the HFEA have sought expert consultations and public opinions to establish guidelines. UK has made social consensus through continued discussion for a long time. US President's veto power was one strongest factors influencing policy. South Korean policy was influenced by public opinion and policy brokers. Also, South Korea has not made social consensus. UK had a strong leadership and strong adjustment of coalitions but US and South Korea had not. Dr. Hwang's scandal has had one of the greatest impacts on policy decision in South Korea. Conclusion: The power of public opinion was critical in all three countries. In particular, the influence of public opinion was noticeable in South Korea. Also it turned out that in US and South Korea, the presence of a policy broker who could pursue his or her goals was the most powerful factor among the advocacy coalition factors.
Policy Elites' Perception of Health Policy Governance: Findings from In-depth Interviews of Korean New Diagnosis Related Group Payment
Shon, Changwoo ; Kwon, Soonman ; You, Myoungsoon ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 326~342
DOI : 10.4332/KJHPA.2013.23.4.326
Background: Engaging and Involving stakeholders who have different interests in changing health care policies are difficult task. As the literature on the governance in Korean health care field is rare, this study aims to provide empirical evidence of 'governing health policy'-the ways health care policy is made, implemented, and evaluated from a political perspective. Methods: The authors of this study conducted interviews with elites in policy and clinical areas, which was considered to be the most effective approach to gather in-depth information about the background of changing payment policy as well as the barriers or contributors for making the policy sustainable. A total of 14 experts (3 government officials, 2 representatives from medical profession, 3 professors form academic field, and 6 healthcare providers from New DRG pilot program hospitals) participated in 2 hour long interviews. Results: There was a perception gap of the feasibility and substantiality of new payment system among elites. The score was higher in government officers than those in scholars or clinical experts. Next, the interviewees indicated that Korean New DRG might not sustain without significant efforts to improving democratic aspects of the governance. It is also notable that all interviewees except healthcare providers provided negative expectation of the contribution of new payment system to increase administration efficiency. For clinical efficiency, every stakeholders perceived there was no increased efficiency after introduction of New DRG payment. Like general perception, there was a wide gap between the perception of stakeholders in quality change after implementing the new payment system. Finally, interview participants negatively assumed about the likelihood of New DRG to remain a case of successful reforms. Conclusion: This study implied the importance of social consensus and the governance of health policy.
Comparison Actual Conversion Factor with Estimated Conversion Factor by Fee Adjustment Model Reflecting Health Service Volume
Han, Ki Myoung ; Cho, Min Ho ; Lee, Soo Jin ; Chun, Ki Hong ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 343~348
DOI : 10.4332/KJHPA.2013.23.4.343
Background: Price control alone may not successfully restrain growth in health expenditures. This study aimed to propose fee adjustment model suitable for Korea reflecting health service volume and to clarify applicability of the model by comparing actual conversion factor with estimated conversion factor from simulation of this model. Methods: Fee adjustment model was developed based on Alberta's fee adjustment formula in Canada and 7 alternatives were assessed according to diversely applied parameters of the model. Results: Estimated conversion factors of the tertiary care hospital and the hospital were lower than actual conversion factors, since the utilization of heath service has been increased. However, there was no big difference between estimated conversion factors and actual conversion factors of the general hospital and the clinic. Eventually this fee adjustment model could estimate proper conversion factor reflecting health service volume. Conclusion: This model may be applicable to the mechanism as determining conversion factor between insurer and provider via negotiation and controling growth in health expenditures.
Economic Analysis of Latent Tuberculosis Infection Screening Strategies in Korea
Kim, Sang-Won ; Kang, Gil-Won ; Shin, Sam-Chul ; Song, Seung-Eun ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 349~357
DOI : 10.4332/KJHPA.2013.23.4.349
Background: Although interferon-gamma release assay (IGRA) is now available alternatives to tuberculin skin test (TST) for detection of latent tuberculosis infection (LTBI), the cost of IGRA test is much higher than TST. So economic analysis of LTBI screening strategies have been done in many countries, but there are few reports in Korea. This study examined cost analysis of LTBI screening strategies in Korea. Methods: The economic outcomes were evaluated by five strategies. These were 1) TST alone, 2) IGRA alone, 3) combination of TST and IGRA (TST followed by IGRA) and 4) no testing no prevention, 5) no testing all prevention. Last two strategies were added to compare with three main LTBI screening strategies. Decision analysis model were used to perform economic analysis. A cohort study of Korean Institute of Tuberculosis and the data of published literatures were used to estimate the cost analysis. Results: In a base-case scenario which was assumed that TST specificity was 80%, TST alone was the least expensive strategy. In a alternative scenario which was assumed that TST specificity was 97%, the combination of TST and IGRA was the least expensive strategy. Sensitivity analysis shows that patients adherent rate to LTBI treatment, TST sensitivity, IGRA sensitivity and IGRA specificity did not have a significant impact on the outcomes. Conclusion: In Korea, for the diagnosis of LTBI at the time of child and adolescent, TST alone reduces medical costs compared with IGRA alone or combination of TST and IGRA.
Relationship between the Suicidal Ideation of the Married Women and the Characteristics of Their Children
Kim, Eunjung ; Lee, Sunmi ; Lim, Seungji ; Chung, Woojin ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 358~368
DOI : 10.4332/KJHPA.2013.23.4.358
Background: There are some data to support the theory of a protective effect of parenthood against suicide, as proposed by Durkheim in 1897. We conducted this study to examine the relationship between children characteristics and suicidal ideation among Korean married women. Methods: The data were obtained from the Korean National Health and Nutrition Examination Surveys IV, conducted in 2007-2009, respectively (3,202 married women aged 20-49 years). The children characteristics are the age of the youngest child and the number of children living with subject. Data were analyzed by using logistic regression with SAS 9.2. Results: The risk for suicidal ideation was higher among married women having a young child (aged <7 years). It had strong effect on suicidal ideation in non-employee subjects. The odds ratio for suicidal ideation of women having a youngest child aged 2-3 years compared with reference groups was 1.673 with statistical significance. But the association of suicidal ideation with number of children shows insignificant. Conslusion: The findings suggest a different result with the theory, the protective effect of being a parent of young child on suicide risk for women, first suggested by Durkheim and supported by previous studies and the need for further prospective investigation that lead to policies according children characteristics aimed at improving married women's life.
Employment Transitions and Suicide Ideation among Echo Generation
Ra, Chaelin Karen ; Lee, Hyunkyung ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 369~375
DOI : 10.4332/KJHPA.2013.23.4.369
Background: This study aimed to investigate the association between employment transitions and suicide ideation among the echo generation. Methods: This study used survey data from the 2008 and 2010 Seoul Welfare Panel Study (Wave I, II). The sample population was restricted to the echo generation aged between18 and 31, and the total of 882 samples were included in the final dataset. Employment transitions were categorized into four groups. The groups were defined as 'employed-employed', 'unemployed-employed', 'employed-unemployed', and 'unemployed-unemployed'. We used logistic regression to find out the association between employment transitions and suicide ideation among the echo generation. Results: 'Employed-unemployed' and 'unemployed-unemployed' groups were likely to have an association with depression (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.46 to 1.51; OR, 1.57; 95% CI, 1.56 to 1.59) accordingly. 'Unemployed-unemployed' group also was related to suicide ideation (OR, 1.39; 95% CI, 1.36 to 1.42). Interestingly, 'unemployed-employed' group showed a strong association with suicide ideation among the echo generation (OR, 3.85; 95% CI, 3.75 to 3.95). Conclusion: Experience in unemployment increases the risk of depression and suicide ideation. Moreover, the precarious job also increases the risk of suicide ideation.
Estimate over the Number of Chronic Disease Patients and Medical Care Expenditure at the Time of Transition of Baby Boomer into 65 Years Old Aging Population
Lee, Sun-Young ; Kim, Young-Hoon ; Kim, Han-Sung ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 376~386
DOI : 10.4332/KJHPA.2013.23.4.376
Purpose: The purpose of study is to estimate the number of chronic disease patients and medical care expenditure at the time baby-boomers belong to 65 years old aging population, and compare with current 65 year-old aging population. Methods: Analysis method used an estimating formula devised by the researcher and estimated the number of chronic disease patients and medical care expenditure of each generation. Results: When comparing the estimated number of chronic diseases patients of each generation, 40.6% of the first generation, 76.4% of the second generation, 95.2% of third generation are expected to get chronic disease. When comparing each generation's total medical care expenditure, based on the estimated number of chronic diseases patients of each generation, the second generation( 1,206,251,224 thousand won) showed higher than other generation. This study compared the number of chronic disease patients and medical care expenditure between the second generation of the elderly and current elder generation. As a result, the second generation patients was higher than the fourth generation in high blood pressure, diabetes, psychological and behavioral disorder, and neurological diseases whereas the fourth generation is only high the number of patients in heart disease. As for total medical care expenditure, the second generation paid more in high blood pressure, psychological and behavioral disorder while the fourth generation in neurological disease and heart disease. Conclusion: It is desired that considering the number of chronic disease patients and medical care expenditure of baby boomers accounting for 14.6% of total population, in-depth follow-up study is carried out that inquires into what are issues with a current chronic disease management project, what business is needed in order to manage these issues, and how to fund to cover increasing medical care expenditure.
Analysis on Factors Relating to External Medical Service Use of Health Insurance Patients Using Spatial Regression Analysis
Roh, Yun Ho ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 387~396
DOI : 10.4332/KJHPA.2013.23.4.387
Background: The purpose of this study was to analyze the association between areas of Korea Train Express (KTX) region and external medical service use in Korean society using spatial statistical model. Methods: The data which was used in this study was extracted from 2011 regional health care utilization statistics and health insurance key statistics from National Health Insurance Corporation. A total spatial units of 229 districts (si-gun-gu) were included in this study and spatial area was all parts of the country excepted Jeju, Ulleungdo island. We conducted Kruskal-Wallis test, correlation, Moran's I and hot-spot analysis. And after, ordinary linear regression, spatial lag, spatial error analysis was performed in order to find factors which were associated with external medical service use. The data was processed by SAS ver. 9.1 and Geoda095i (windows). Results: Moran's I of health insurance patients' external medical service use was 0.644. Also, population density, Seoul region, doctor factors positively associated with health insurance patients' external medical service. In contrast, average age, health care organization per 100 thousand were negatively associated with health insurance patients' external medical service use. Conclusion: The finding of this study suggested that health insurance patient's external medical service use correlated for seoul region in korea. The study results imply the need for more attention medical needs in the region (si-gun-gu unit) for health insurance patients of seoul region. It is important to adapt strategy to activation of primary health care as well as enhancing public health institution for prevent leakage of patients to other areas.
What Factors Are Linked to Profitability among Hospitals?: A Review on the Research Trends
Choi, Jae-Young ; Kim, Jee-Hyun ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 397~414
DOI : 10.4332/KJHPA.2013.23.4.397
There have been numerous attempts at finding factors associated with profitability among hospitals in the Republic of Korea. Factors that have been shown to be related to hospital profitability have not yet been systematically reviewed. The purpose of this study was to compile and summarize published works investigating the factors associated with hospital profitability in the Republic of Korea. We searched Research Information Sharing Service, Korea studies Information Service System, Database Periodical Information Academic, Korean Medical Database, KoreaMed, and Google Scholar from 1980 to November 2013. In addition, we manually searched reference lists from eligible studies. Review of 20 peer-reviewed articles revealed that very few of the variables employed in the eligible studies exerted consistent association with profitability, with the exception of personal cost (i.e., employee salaries). Future studies should take our findings into consideration before conducting research on hospital profitability.
Development of Public Health Center Image Scale
Lee, In Young ; Kim, Eun Mi ; Bae, Sang Soo ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 415~426
DOI : 10.4332/KJHPA.2013.23.4.415
Background: This study was aim to identify the specific words and to develop the scale for the public health center (PHC) image. Methods: We collected 824 words from the previous studies and by open questions and reduced them by 77 words, then which were rated properly by 355 citizens of Seoul. We examined explanatory factor analysis for 69 words, and examined content validity test and confirmatory factor analysis (CFA) for the image structures (4 factors and 16 words). And then we developed the image questionnaire using them through council. We conducted a survey and retested the PHC image scales as the measuring tool targeting 2,000 persons, and compared the inexperience and experience persons for PHC usage. Results: The image structures were consisted of 4 factors and 16 words such as 'trustworthiness' (warm, exemplary, faithful, service-mindedness, beneficial to health), 'fairness' (honesty, clear, consistent, ruled), 'development possibility' (changing, goal-directed, developmental, propulsive), and 'flexibility' (not authoritative, not perfunctory, not rigid) in total. Cronbach's
values of all factors were above 0.7. As a result of CFA, model fit indexes yielded satisfactory results (root mean square error of approximation [RMSEA] 0.049, goodness of fit index [GFI] 0.937, and adjusted goodness of fit index [AGFI] 0.912). According to the result of retest for measuring tool by using other samples, Cronbach's
values were above 0.8, and model fit indexes yielded satisfactory results (RMSEA 0.059, GFI 0.952, AGFI 0.933). RMSEAs of the inexperiences and the experiences were each 0.59, 0.68. Conclusion: A reliable, valid, and generalizable scale was created for PHC image.
The Effect of a Clinic Based Incentive Program on Medication Adherence among Patients with Hypertension or Diabetes Mellitus in Incheon
Cheong, Won ; Yim, Jun ; Oh, Dae-Kyu ; Im, Jeong-Soo ; Ko, Kwang Pil ; Park, Ie Byung ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 427~433
DOI : 10.4332/KJHPA.2013.23.4.427
Background: This study was conducted to evaluate the factors affecting adherence in patients with hypertension and type 2 diabetes mellitus before and after a clinic based patient incentive program in Incheon. Methods: An observational follow-up study was done for 28,355 patients in one registered group and 245,598 patients in a non-registered group from March 16th 2009 to December 31th 2010 in Incheon. The registration, mandatory laboratory tests and number of clinic visits were collected by merging the Incheon Chronic Disease Management System data and the National Health Insurance Corporation (NHIC) data. As a measure of patient adherence, we used a variable of prescription days from the NHIC and defined above 80% of average prescription days as an appropriate patient adherence. Repeated measures analysis of variance and logistic regression were used to analyze the differences in patient adherence and factors affecting adherence. Results: The changes in prescription days for the registered group are larger than for the non-registered group. In the logistic regression model, including the variables with sex, age, income status and number of clinic visits, the registered group exhibited a higher Odds ratio in the patient adherence. Conclusion: This study revealed the association between registration and appropriate patient adherence in patients with hypertension or type 2 diabetes mellitus.
Development and Validation of the Measurement Tool of Public Benefits in Regional Cardiocerebrovascular Center
Lee, Kunsei ; Shin, Eunyoung ; Jeong, Hyoseon ; Lee, Jung-Hyun ; Kim, Hee-Sook ; Lim, Young Sil ; Kim, Young Taek ;
Health Policy and Management, volume 23, issue 4, 2013, Pages 434~444
DOI : 10.4332/KJHPA.2013.23.4.434
Background: Regional Cardiocerebrovascular Centers (RCC) were established for the prevention and treatment of cardiocerebrovascular disease and funded by the Ministry of Health and Welfare. The purpose of this study was to develop and validate the measurement tool of public benefits in RCC. Methods: Through the intensive literature review, experts surveys and their repetitive feedback, we selected the 46 items about the public benefits in RCC. Development of measurement tool involved content validity test using Content Validity Index (CVI), construct validity test through factor analysis and reliability test. Results: Thirty-five items were selected by content validity test, which CVI was 0.08 or higher. Through the construct validity test, 32 items in 7 factors were derived. And Cronbach's alpha was 0.951. Finally, public benefits measurement tool is composed of 32 items in 7 factors which are comprehensiveness of health care services, market complement, emergency care, cost, governance, quality improvement, and government control. Conclusion: Though we developed the measurement tool of public benefits in RCC, it would be utilized to measure the public benefits of various health agencies.