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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
Editor in Chief :
Volume & Issues
Volume 24, Issue 4 - Dec 2014
Volume 24, Issue 3 - Sep 2014
Volume 24, Issue 2 - Jun 2014
Volume 24, Issue 1 - Mar 2014
Selecting the target year
Raise the Cigarette Price Significantly, and Propose the Local Health Promotion Fund
Park, Yoon Hyung ;
Health Policy and Management, volume 24, issue 3, 2014, Pages 203~204
DOI : 10.4332/KJHPA.2014.24.3.203
An Implementation Analysis of the National Health Insurance Coverage Expansion Policy in Korea: Application of the Winter Implementation Model
You, Sooyeon ; Kang, Minah ; Kwon, Soonman ;
Health Policy and Management, volume 24, issue 3, 2014, Pages 205~218
DOI : 10.4332/KJHPA.2014.24.3.205
Background: Most studies on the national health insurance benefit expansion policy have focused on policy tools or decision-making process. Hence there was not enough understanding on how policies are actually implemented within the specific policy context in Korea which has a national mandatory health insurance system with a dominant proportion of private providers. The main objectives of this study is to understand the implementation process of the benefit coverage expansion policy. Unlike other implementation studies, we tried to examine both the process of implementation and decision making and how they interact with each other. Methods: Interviews were conducted with the ex-members of the Health Insurance Policy Review Committee. Medical doctors who implement the policy at the 'street-level' were also interviewed. To figure out major variables and the degree of their influences, the data were analyzed with Winter's Policy Implementation Model which integrates the decision making and implementation phases. Results: As predicted by the Winter model, problems in the decision making phase, such as conflicts among the members of committee, lack of applicable causal theories application of highly symbolic activities, and limited attention of citizen to the issue are key variables that cause the 'implementation failure.' In the implementation phase, hospitals' own financial interests and practitioners' dependence on the hospitals' guidance were barriers to meeting the policy goals of providing a better coverage for patients. Patients, the target group, tend to prefer physicians who prescribe more treatment and medicine. To note, 'fixers' who can link and fill the gap between the decision-makers and implementers were not present. Conclusion: For achieving the policy goal of providing a better and more coverage to patients, the critical roles of medical providers as street-level implementers should be noted. Also decision making process of benefit package expansion policy should incorporate its influence on the implementation phase.
The Common Patterns of Multimorbidity and Its Impact on Healthcare Cost in Korea
Kim, Chang-Hoon ; Hwang, Inkyung ; Yoo, Weon-Seob ;
Health Policy and Management, volume 24, issue 3, 2014, Pages 219~227
DOI : 10.4332/KJHPA.2014.24.3.219
Background: Current trends in Korea population aging with advances in public health and clinical medicine foretell rises in the prevalence of not only chronic diseases but also patients with multimorbidity. One important aspect in analyzing multimorbidity is to define the list of chronic diseases included when calculating multimorbidity index. The objective of this study is to describing the effect of multimorbidity on healthcare cost in Korea using US Office of the Assistant Secretary of Health (OASH) list. Methods: We analyzed the Korea Health Panel Data representing non-institutionalized Korean adult populations aged 20 and more. We calculated multimorbidity index based on OASH list and estimated the prevalence and healthcare cost for each OASH chronic disease. Results: In 2011, 15.2 million (39.6%) Koreans aged 20 and more were living with chronic condition. The health care cost due to chronic diseases, accounted for 80.2% of the overall healthcare costs and the prevalence of chronic conditions, the prevalence of multimorbidity and healthcare cost increased with ages. In the analysis using OASH list, 40% of the adult population over the age of 20 and 66.7% of the population over the age of 65 was affected with multimorbidity. In most of diseases in OASH list, prevalence of mulitmorbidity was high and healthcare cost increased with multimorbidity. Conclusion: OASH chronic disease list that accounts for 72.4% of prevalence and 86.7% of healthcare cost of persons with chronic conditions in Korea. OASH chronic disease list would be a useful and representative indicator for studying multimorbidity.
Effect of Expanding Benefit Coverage for Cancer Patients on Equity in Health Care Utilization and Catastrophic Expenditure
Kim, Ji Hye ; Kim, Su Jin ; Kwon, Soon Man ;
Health Policy and Management, volume 24, issue 3, 2014, Pages 228~241
DOI : 10.4332/KJHPA.2014.24.3.228
Background: The purpose of this study is to evaluate the effect of health insurance coverage expansion for cancer patients on equity in health care utilization and catastrophic expenditure. Methods: To analyze the causal relationship between the policy to expand benefit coverage and the change in health care utilization and out-of-pocket payments of cancer patients, this study employed a difference-in-differences (DID) method. In the DID model, the change in health care utilization, such as health care expenditure, visit days and length of stay, of cancer patients was compared with that of liver disease patients, using Korea Health Panel Data in 2009 and 2010. Results: The policy of reducing cost sharing from 10% to 5% for cancer patients did not have significant effects on equity in health care utilization. The results of this study were different from those of the previous study that showed that the reduction of cost sharing from 20% to 10% significantly improved the equity in health care utilization of cancer patients. In addition, the result of catastrophic expenditures analysis showed the policy did not change the probability of catastrophic expenditures. Conclusion: The results of this study imply that payment for non-covered services account for high out-of-pocket payments, and the reduction in cost sharing for covered services alone may have a limited effect on total financial burden on patients.
The Effect of Catastrophic Health Expenditure on the Transition to and Persistence of Poverty in South Korea: Analysis of the Korea Welfare Panel Study Data, 2007-2012
Song, Eun-Cheol ; Shin, Young-Jeon ;
Health Policy and Management, volume 24, issue 3, 2014, Pages 242~253
DOI : 10.4332/KJHPA.2014.24.3.242
Background: The low benefit coverage rate of South Korea's health security system causes catastrophic health expenditure. And catastrophic health expenditure can be the cause of the transition to and persistence of poverty. This study was conducted to ascertain the effect of catastrophic health expenditure on the transition to and persistence of poverty, using 6 years of the Korea Welfare Panel Study Data. Methods: This study was conducted among the 22,528 households that participated in the Korea Welfare Panel Study, 2007-2012. Catastrophic health expenditure was defined as equal to or exceeds thresholds (10%, 20%, 30%, and 40%) of household's capacity to pay. The effect of catastrophic health expenditure on the transition to and persistence of poverty was ascertained via multivariate logistic regression. Results: Four-point-seven percent to 20.6% of the households are facing catastrophic health expenditure. Rates of the transition to (relative risk [RR], 18.6 to 30.2) and persistence of (RR, 74.8 to 76.0) poverty of households facing catastrophic health expenditure was higher than households not facing catastrophic health expenditure. Even after adjusting the characteristics of the household and the household head, catastrophic health expenditure was found to affect transition to (odds ratio [OR], 2.11 to 3.04) and persistence of (OR, 1.53 to 1.70) poverty. Conclusion: To prevent catastrophic health expenditure and transition to and persistence of poverty resulting from catastrophic health expenditure, the reinforcement of South Korea's health security system including the benefit coverage enhancement is required.
Analysis of Appropriate Outpatient Consultation Time for Clinical Departments
Lee, Chan Hee ; Lim, Hyunsun ; Kim, Youngnam ; Park, Ai Hee ; Park, Eun-Cheol ; Kang, Jung-Gu ;
Health Policy and Management, volume 24, issue 3, 2014, Pages 254~260
DOI : 10.4332/KJHPA.2014.24.3.254
Background: The purpose of this study is to assume appropriate outpatient consultation time for each clinical department on the basis of measured outpatient consultation time and satisfaction of outpatient. Methods: We surveyed the feeling and satisfactory outpatient consultation time, satisfaction, revisiting intention and recommendation to others to 1,105 patients of single general hospital in Gyeonggi-do and measured their real outpatient consultation time from October 28 to November 27 in 2013. On the basis of satisfaction, we estimated appropriate outpatient consultation time through area under the receiver operating characteristic curve in logistic regression model. Results: Feeling outpatient consultation time was 5.1 minutess, satisfactory outpatient consultation time which was suggested by patient was 6.3 minutes, and real outpatient consultation time was 4.2 minutes. Department which had longest real outpatient consultation time was infection (7 minutes) and department which had longest satisfactory outpatient consultation time was neurology (9.4 minutes). From the univariate and the multiple linear regression analysis, real outpatient consultation time was longer in pulmonology patient, new patient and afternoon patient, satisfactory outpatient consultation time was longer in infection, neurology, neuropsychiatry, neurosurgery, and rehabilitation patient. Appropriate real outpatient consultation time was suggested as 5.6 minutes which differentiated high and low satisfied patient group. However, we could not assume appropriate outpatient consultation time for each clinical department because the number of patient who had bad satisfaction was too low. Conclusion: To improve patient's satisfaction, we hope outpatient reservation system is operated as each patient's outpatient consultation time is at least 5.6 minutes.
What Factors Cause a Complete Examination of Infant Health Checkup?
Kang, Seungjin ; Chung, Woojin ; Kim, Heejin ; Lee, Sunmi ;
Health Policy and Management, volume 24, issue 3, 2014, Pages 261~270
DOI : 10.4332/KJHPA.2014.24.3.261
Background: This study examined what factors affected a complete examination of infant health checkup. Methods: We used Korean national health insurance claim data of 2,936,650 infants, taking examination in 2012. These claim data included enrollment status of householders and records of infant health checkup from 2008 to 2013. Results: Our results shows that for infant characteristics, the likelihood of complete examination of infant health checkup is significantly lower in female, older aged, and handicapped ones. For householder characteristics, the likelihood of complete examination of infant health checkup is also significantly lower in female, older group and self-employed ones. For household characteristics, the likelihood of complete examination is also significantly lower in single-parent families, multi-cultural families, parent with unexperienced health checkup and lower monthly premiums. Conclusion: It is necessary to support an additional use-guide and follow-up management services to improve incomplete examination of infant health checkup.
Effects of Surgery Volume on In Hospital Mortality of Cancer Patients in General Hospitals
Youn, Kyung-Il ;
Health Policy and Management, volume 24, issue 3, 2014, Pages 271~282
DOI : 10.4332/KJHPA.2014.24.3.271
Background: Although the mortality rate in cancers has been decreased recently, it is still one of the leading causes of death in most of the countries. This study analyzed the relationship between surgery volume and in hospital mortality of cancer patients. The purpose of this study is to investigate the relationship in Korean healthcare environment and to provide information for the policy development in reducing cancer mortality. Methods: The study sample was the 20,517 cancer patients who underwent surgery and discharged during a month period between 2008-2011. The data were collected in Patient Survey by Korean Institute of Social Affairs. Logistic regression was used to analyse a comprehensive analytic model that includes a binary dependent variable indicating death discharge and independent variables such as surgery volume, organizational characteristics of hospitals, socio-economical characteristics of the patients, and severity of disease indicators. Results: In chi-square test, as the surgery volume increases, the in-hospitals mortality showed a downward trends. In regression analysis, the relationship between surgery volume and mortality showed significant negative associations in all types of cancer except for pancreatic cancer. Conclusion: In the absence of other information patients undergoing cancer surgery can reduce their risk of operative death by selecting a high-volume hospital. Therefore, policies to enhance centralization of cancer surgery services should be considered.
The Relationship between Home-Visit Nursing Services and Health Care Utilization among Nursing Service Recommended Beneficiaries of the Public Long-Term Care Insurance
Kang, Sae Bom ; Kim, Hongsoo ;
Health Policy and Management, volume 24, issue 3, 2014, Pages 283~290
DOI : 10.4332/KJHPA.2014.24.3.283
Background: This study aimed to examine the relationship between home-visit nursing services and health care utilization under the public long-term care insurance program in Korea. Methods: We analyzed the long-term care need assessment database and the long-term care and the health insurance claim databases of National Health Insurance Service between July 2011 and June 2012. The sample includes a total of 20,065 home-visit nursing recommended-older beneficiaries who use home-visit nursing and/or home-visit care, based on a standard benefit model developed by the Health Insurance Policy Institute of National Health Insurance Service. The beneficiaries were categorized into home-visit nursing use and non-use groups, and the home-visit nursing use group was again divided into high-use and low-use groups home-visit nursing, based on their total annual home-visit nursing expenditure. Two-part models and negative-binomial regression models were used for the statistical analysis. Results: The home-visit nursing use was negatively associated with the number of outpatient visit and cost, while adjusting for all covariates. The home-visit nursing use was also negatively associated with the inpatient cost among the high home-visit nursing use group. Conclusion: The findings implies home-visit nursing use prevents health care utilization. Further studies and policy strategies that can promote and strengthen home-visit nursing services under the public long-term care insurance are necessary in Korea.
Knowledge Management Activity and Performance of University Hospital Employees
Lee, Hyun-Sook ;
Health Policy and Management, volume 24, issue 3, 2014, Pages 291~300
DOI : 10.4332/KJHPA.2014.24.3.291
Background: The efficient knowledge management in hospital organization is generally known as the important activities relevant to employees' knowledge sharing behavior and work performance. This research examined factors affecting employees' knowledge sharing behavior and work performance in top 4 university hospitals. This study is based on individual factors such as incentives, reciprocity, behavioral control, and subjective norms. Also, there are organizational factors such as CEO support, learning climate, IT system, rewards system, and trust. Methods: Data was collected from employees who are working at 3 hospitals university in Seoul and 1 university hospital in Gyeonggi-Do through the self-administered questionnaires. A total of 779 questionnaires were analyzed by PASW SPSS ver. 18.0. (SPSS Inc., Chicago, IL, USA). Results: The significant variables affecting knowledge sharing behavior are behavioral control (in individual factor) and CEO, IT system, and trust (in organization factor). Also the significant variables affecting work performance are incentives, reciprocity, subjective norms, and behavioral control (in individual factor) and CEO support, IT system, reward system, and trust (in organization factor). Conclusion: The personality and organization characteristics factors is important to improve knowledge sharing behavior and work performance of hospital employees. Therefore, to make more efficient knowledge management is to build and system knowledge sharing culture, system, and leadership and to develop practical strategies.