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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Health Policy and Management
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Journal DOI :
The Korean Society of Health Policy and Administration
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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
Suggestion for New Strategy and Governance of Health Care Delivery System
Park, Yoon Hyung ;
Health Policy and Management, volume 24, issue 4, 2014, Pages 301~303
DOI : 10.4332/KJHPA.2014.24.4.301
In Search of Integrated Health Care System Tailored to Korea
Shin, Young Seok ; Yoon, Jangho ;
Health Policy and Management, volume 24, issue 4, 2014, Pages 304~311
DOI : 10.4332/KJHPA.2014.24.4.304
This manuscript treats a new paradigm for the Korean health care system. We give an account of innovative health care delivery and payment models widely discussed in the contemporary US accountable care organization and coordinated care organization. In doing so, we explore a new health care model amenable to foreseeable changes to the health care system. We propose creating an integrated health care system in which the network of health care providers delivers coordinated and comprehensive care for enrolled patients residing within the geographic boundaries served by the provider network; providers may participate voluntarily in one or more networks and assume shared responsibility for patient care and cost; provider networks compete with each other based on cost and quality; and consumers are allowed to choose a network. We expect that the new paradigm will create a financially-sustainable system that assures quality of care and improves patient experience, minimizing the existing system-wide inefficiency through cross-network competition and within-network care coordination.
Evaluating Chronic Care of Public Health Centers in a Metropolitan City
Choi, Yong-Jun ; Shin, Dong-Soo ; Kang, Minah ; Bae, Sang-Soo ; Kim, Jaiyong ;
Health Policy and Management, volume 24, issue 4, 2014, Pages 312~321
DOI : 10.4332/KJHPA.2014.24.4.312
Background: To evaluate the quality of chronic care provided by public health centers located in a South Korean metropolitan city using a modified Assessment of Chronic Illness Care (ACIC). Methods: We conducted self-evaluation surveys and collected data using a modified ACIC from twenty five public health centers. Cultural validity of the original ACIC was examined by the public health and nursing science experts. Based on expert reviews, cognitive interviews, pre-test results, five items of the original ACIC that were not relevant were deleted. The response scale was changed from twelve-point Likert scale to Guttman scale but its scoring system was maintained. Results: Eighty eight percent of public health centers in this study reported that their overall quality of chronic care was at a limited or basic level. About 68% of the centers reported that the organization was as reasonably good or fully developed to provide chronic care. On the other hand, 96% of the public health centers reported that the clinical information system was at a very limited or basic support level. The decision support, the integration of Chronic Care Model components, the delivery system design, the community linkages, and the self-management support were evaluated as limited or basic level of support by more than half of the public health centers, respectively. Conclusion: In a metropolitan area of South Korea, quality of chronic care in public health centers was not found to reach acceptable levels of services. It is critical to enhance the quality of chronic care in public health centers.
A Comparative Study of the Disease Codes between Korean National Health Insurance Claims and Korean National Hospital Discharge In-Depth Injury Survey
Bae, Soon-Og ; Kang, Gil-Won ;
Health Policy and Management, volume 24, issue 4, 2014, Pages 322~329
DOI : 10.4332/KJHPA.2014.24.4.322
Background: As most of people in Korea are covered by National Health Insurance (NHI), the disease information collected in NHI provides high availability for health policy. Nevertheless, the validity of disease codes in NHI data has been controversial till now. So we tried to evaluate the validity of them by comparing the NHI claims data with Korean National Hospital Discharge In-depth Injury Survey (KNHDIIS) data. Methods: We compared the NHI patients sample data (2009) with the KNHDIIS data (2009). We selected the inpatient data of KNHDIIS and NHI patients sample. The weighted number of patients from NHI patients sample was 5,551,210 and the number of patients from KNHDIIS was 5,559,874. We classified the disease codes into principal diagnoses and other diagnoses, and we compared as one, two, three unit level. Also we calculated the agreement rate of each of them. Results: In the comparison of principal diagnoses, NHI claims data had more C code than KNHDIIS data did, whereas KNHDIIS data had more Z code than NHI claims data did. In the comparison of other diagnoses, NHI claims data had 2, 3 more codes than KNHDIIS data did. The overall agreement rate at three unit level was 76.5% in principal diagnoses and 46.8% in other diagnoses. Conclusion: Considering the large difference between the two data, the validity of disease codes in NHI Claims data seems to be low. To increase the validity of them, the definite detail coding indicator, the reinforcement of coding education, and the reform of system are needed.
Factors Influencing Union Members' Participation in the Korean Health Cooperatives
Kim, Kwang-Myo ; Park, Eunyoung ; Lee, Kun-Sei ; You, Myoungsoon ; Kim, Chang-Yup ;
Health Policy and Management, volume 24, issue 4, 2014, Pages 330~341
DOI : 10.4332/KJHPA.2014.24.4.330
Background: The purpose of this study is to investigate the factors that affect the participation of union members who involved in the Korean health cooperatives. Methods: Questionnaires were collected from 1,041 respondents who voluntarily participated in seven health cooperatives. In order to verify the hypothesis, collected data were analyzed using binomial logistic regression. Results: Longer tenure, higher collective motive, organizational age were associated with types of participation. In operative participation, marital status, higher reward motive, better accessibility to the cooperatives influenced concern about the high-level participation. Organizational age were associated with the high-level participation in management participation. Longer tenure, interaction with staff, management participation were involved in additional investment. Conclusion: This is the first study to statistically prove that the influencing factors on the participation in the health cooperatives. Based on these findings, the provision of differentiated strategies should be useful for increase of participation.
Evaluation of Tobacco Control Policy in Korea: Development and Application of the Korean Tobacco Index for Policy Monitoring and Evaluation
Hwang, Ji-Eun ; Oh, Yu-Mi ;
Health Policy and Management, volume 24, issue 4, 2014, Pages 342~348
DOI : 10.4332/KJHPA.2014.24.4.342
Background: Due to lack of regular and systematic evaluation tool, Korea's tobacco control policy has not been examined its overall process of implementation including efficiency and adequacy of the policies. This study developed policy monitoring and evaluation model to assess policy implementation and effectiveness of tobacco control in Korea. Methods: Based on World Health Organization operational manual for assessment, MPOWER (monitor tobacco use and prevention policies, protect from tobacco smoke, offer help to quit tobacco use, warn about the dangers of tobacco, enforce bans on tobacco advertising promotion and sponsorship, and raise taxes on tobacco) related policies were reviewed by rating policy efforts, programme management, people (human resources and their development), provision of organization, provision of fund and partnerships (range, 0 to 5). Results: As a result of the experts' assessment, overall Korean tobacco control policies scored 2.61 points, which is poor. In relation to each 'MPOWER' policies, 'W' scored the highest points (2.93), followed by 'O' (2.91), 'M' (2.87), 'P' (2.86), and 'E' (2.23). 'R' scored the lowest points of 1.87, meaning government efforts in tobacco price policy is insufficient. Conclusion: This study concludes that Korean tobacco control policy should strengthen tax and price measures, while programme infrastructure, people, and funds for policy enforcement should be secured. Furthermore, rather than focusing on one specific measure, a balanced approach reflecting various aspects of tobacco controls should be considered in order to decrease smoking rates and prevent smoking initiation.
Factors Associated with the Non-Use of Beneficiaries of Long-Term Care Insurance Service: The Case of Jeollanam-do Province
Kuk, Kyung-Nam ; Kim, Roeul ; Lim, Seungji ; Park, Chong-Yon ; Kim, Jaeyeun ; Chung, Woojin ;
Health Policy and Management, volume 24, issue 4, 2014, Pages 349~356
DOI : 10.4332/KJHPA.2014.24.4.349
Background: This study aimed to explore factors associated with the non-use of beneficiaries of long-term care insurance services for the elderly in Jeollanam-do Province by analyzing a dataset obtained from National Health Insurance Service. Methods: The study sample consists of 1,663 individuals who were evaluated as eligible for long-term care insurance services in Jeollanam-do Province during the period of July 1, 2008 through June 30, 2009. As a dependent variable, the non-use of the service was defined as one when a beneficiary had used it once or more times during one year after he or she was evaluated as eligible and as zero otherwise. A proportion analysis was conducted to describe characteristics of study sample. Chi-square tests were used to compare general characteristics between beneficiaries who had used the services and those who had not used them. Multiple logistic regressions were performed by three models including additional sets of explanatory variables such as socio-demographic characteristics, health conditions, and economic status. Results: Main results are summarized as follows. The proportion of beneficiaries who had not used the service was 14.5% of all beneficiaries. According to the results from the model using all explanatory variables, the factors associated with the non-use of the services were residence location, dwelling place, type of desired service, level of care needs, and instrumental activities of daily life limitations. Conclusion: In particular, regarding the type of desired service, the cash benefit showed a high likelihood of the non-use of the service; it had an odds ratio (OR) of 50.212 (95% confidence interval [CI], 24.00-105.04) compared with home service. In case of dwelling place, a hospital showed also a high likelihood of the non-use with an OR of 20.71 (95% CI, 10.12-42.44) compared with home.
Unmet Need and Inappropriate Use in Emergency Ambulance Service
Kang, Kyunghee ;
Health Policy and Management, volume 24, issue 4, 2014, Pages 357~366
DOI : 10.4332/KJHPA.2014.24.4.357
Background: The objective of this study was to evaluate the efficiency of an emergency ambulance system and to investigate socio-economic and clinical characteristics associated with emergency ambulance service. Methods: Based on 2011 Korea health panel, unmet need and inappropriate use of emergency ambulance service were measured by Gibson in 1977. Furthermore, the factors associated with unmet need and inappropriate use of emergency ambulance service were identified by Fisher's exact tests and multiple logistic regression models. Results: Unmet need, defined as the proportion of emergency patients who clinically need ambulance transportation but do not receive it, was found to be 59.8%. Inappropriate use, defined as the proportion of emergency patient receiving ambulance care who did not clinically need it, was found to be 37.2%. There were statistically significant differences between appropriate and inappropriate groups in overall variables of socio-economic and clinical characteristics. Specifically, gender, age, relationship to household, and reasons of visiting emergency department (accident/disease) were statistically significant factors associated with appropriate use of emergency ambulance service. Conclusion: Unmet ambulance need is a useful measure for patients needs assessment, and inappropriate ambulance use is a valid criteria in judging the efficiency of emergency ambulance system. To improve and understand emergency ambulance system, unmet need and inappropriate use of emergency ambulance service should be more concerned.
The Effect of Destination Image and Attitude toward Medical Tourism on the Mongolian's Intention to Use Korean Medical Tourism Service
Lee, Eun Joo ; Shin, Taeksoo ; Jin, Ki Nam ;
Health Policy and Management, volume 24, issue 4, 2014, Pages 367~379
DOI : 10.4332/KJHPA.2014.24.4.367
Background: Over the last decade, medical tourism industry has grown in Korea. Especially the number of Mongolian medical tourists has increased rapidly. Therefore, the Mongolia is one of the targets for Korea medical tourism. The purpose of this study is to investigate the effects of destination image and expected attributes of medical services on Mongolian's intention to use Korean medical tourism service. Methods: This study empirically collected survey data from Mongolian lived in Mongolia. The study analyzed the data using a PLS model. Results: Our results are as follows. First, the country image didn't significantly have causal effects on expected medical service quality and perceived risk. Second, tourism image (e.g., entertainment, economic feasibility, and local convenience) has significantly causal effects on expected medical service quality and perceived risk. However, tourist site as tourism image didn't significantly have causal effects on expected medical service quality and perceived risk. Third, medical image made a statistically significant effect on expected medical service quality and perceived risk. Fourth, the expected medical service quality showed a significant effect on intention to use Korean medical tourism service. Fifth, the perceived risk of medical tourism showed a significant effect on the reliability of medical tourism, but didn't show a significant effect on the intention to use Korean medical tourism service. Finally, the reliability has a significant effect on the intention to use Korean medical tourism service. Conclusion: From our empirical results, this study concluded that as a strategy attracting Mongolian patients, it is more effective to strengthen Korean hospital image and tourism image than Korean country image.
Moderating Effect of Structural Complexity on the Relationship between Surgery Volume and in Hospital Mortality of Cancer Patients
Youn, Kyungil ;
Health Policy and Management, volume 24, issue 4, 2014, Pages 380~388
DOI : 10.4332/KJHPA.2014.24.4.380
Background: The volume of surgery has been examined as a major source of variation in outcome after surgery. This study investigated the direct effect of surgery volume to in hospitals mortality and the moderating effect of structural complexity-the level of diversity and sophistication of technology a hospital applied in patient care-to the volume outcome relationship. Methods: Discharge summary data of 11,827 cancer patients who underwent surgery and were discharged during a month period in 2010 and 2011 were analyzed. The analytic model included the independent variables such as surgery volume of a hospital, structural complexity measured by the number of diagnosis a hospital examined, and their interaction term. This study used a hierarchical logistic regression model to test for an association between hospital complexity and mortality rates and to test for the moderating effect in the volume outcome relationship. Results: As structural complexity increased the probability of in-hospital mortality after cancer surgery reduced. The interaction term between surgery volume and structural complexity was also statistically significant. The interaction effect was the strongest among the patients group who had surgery in low volume hospitals. Conclusion: The structural complexity and volume of surgery should be considered simultaneously in studying volume outcome relationship and in developing policies that aim to reduce mortality after cancer surgery.
Factors That Affect Family Planning of Fertile Women in Volta Region in Ghana
Kim, Jae Woo ; Nam, Eun Woo ;
Health Policy and Management, volume 24, issue 4, 2014, Pages 389~395
DOI : 10.4332/KJHPA.2014.24.4.389
Background: Family planning is widely practiced today to resolve the over-growing population and overcome obstacles that thwart socio-economic growth. While Ghana was the first country in Africa to implement family planning program, its birthrate is still twice as much as world average due to weak infrastructure and strategic plans to enforce the policy. Thus, there is a need to objectively verify the factors that affect family planning of fertile women of Ghana. Methods: Total of 630 self-administered questionnaires were distributed from April 8 to 17 of 2013 to collect data. Six-hundred eighteen questionnaires were analyzed, excluding the 12 incomplete questionnaires. Collected data were analyzed using PASW SPSS ver. 18, and logistic regression analysis was performed to verify the factors that affect practice of family planning. Results: Satisfaction with health and medical facilities, experience with family planning education and awareness of birth control methods significantly affected practice of family planning. Based on analysis using odds ratio, enforcement rate of family planning increased by 4.574 times when the subjects were satisfied with health and medical facilities, by 3.920 times when received family planning education, and by 3.284 times when they were aware of birth control methods. Conclusion: By adopting family planning education program, government should be able to change fertile women's perception of family planning. A strategic plan is necessary in order to increase access to medical facilities, improve service satisfaction, and induce women to enforce family planning voluntarily.
An Evaluation of Accountable Care Organization in USA and Policy Implications for Korean Health Care System
Seo, Kyung Hwa ; Jung, Yu Min ; Kim, Min Ji ; Lee, Sun Hee ;
Health Policy and Management, volume 24, issue 4, 2014, Pages 396~412
DOI : 10.4332/KJHPA.2014.24.4.396
Background: As a reform plan of health care system, Accountable Care Organization (ACO) has became an object of attention in the United States after Patient Protection and Affordable Care Act was enacted. ACO is a group of various health care providers and provide coordinated care to its assigned beneficiaries. If ACOs improve the quality level and reduce the cost of care, they can get financial incentives. Under the discussion for a quite long time and demonstration projects, ACO has been established. We aimed to analysis and discuss the history, policy mechanism, contents, status and outcomes of ACO. Also, we intended to suggest political implication Korean health care system with regard to ACO. Methods: We searched the articles related ACO in PubMed and selected several available papers about ACO. Total 56 studies were reviewed and categorized three parts; demonstration projects for formation of ACO, policy mechanism and agenda, empirical results of ACO performance. Results: As a result, establishment of ACO was successful partly in the US. It seems to be due to various project and pilot test for verification in the long time. The empirical effect of ACO was also identified in a few study but it needs more evidences to judge its positive effect. Conclusion: In Korea, there are arguments for the application of ACO. However it is difficult to implement a ACO by different political conditions between Korean and US. Nevertheless ACO proposed us the necessity of paradigm shift in our health policy and could be significant to national policy orientation in the future.