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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Health Policy and Management
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The Korean Society of Health Policy and Administration
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Volume & Issues
Volume 26, Issue 2 - Jun 2016
Volume 26, Issue 1 - Mar 2016
Selecting the target year
Strategy of Research for Developing Model of Community Based Non-Communicable Diseases Control and Prevention
Park, Yoon Hyung ;
Health Policy and Management, volume 26, issue 1, 2016, Pages 1~3
DOI : 10.4332/KJHPA.2016.26.1.1
The prevalence of non-communicable disease (NCD) has been continuously increasing due to population ageing, and the change in consumption and lifestyle patterns. Cancers, cerebrovascular diseases, and hypertensive diseases have been the major causes of deaths in the Republic of Korea since 1983. Numerous studies have suggested the need for a sustained comprehensive treatment tailored for individual patients and recommend the development of a systematic program to manage NCD patients to provide such care. It's necessary to develop the Korean model of the community based NCD prevention and control, consisting strategy of community movement, education for the NCD patients, and partnership the primary care clinic with public health organization to meet the needs in community people.
Hospital Admission Rates for Ambulatory Care Sensitive Conditions in South Korea: Could It Be Used as an Indicator for Measuring Efficiency of Healthcare Utilization?
Jeong, Keon-Jak ; Kim, Jinkyung ; Kang, Hye-Young ; Shin, Euichul ;
Health Policy and Management, volume 26, issue 1, 2016, Pages 4~11
DOI : 10.4332/KJHPA.2016.26.1.4
Background: Hospital admissions for ambulatory care sensitive conditions (ACSCs), which are widely used as an indicator of poor access to primary care, can be used as an efficiency indicator of healthcare use in countries providing good access to health care. Korea, which has a national health insurance (NHI) system and a good supply of health care resources, is one such country. To quantify admission rates of ACSC and identify characteristics influencing variation in Korean health care institutions. Methods: By using NHI claims data, we computed the mean ACSC admission rate for all institutions with ACSC admissions. Results: The average ACSC admission rate for 4,461 institutions was 1.45%. Hospitals and clinics with inpatient beds showed larger variations in the ACSC admission rate (0%-87.9% and 0%-99.6%, respectively) and a higher coefficient of variation (7.96 and 2.29) than general/tertiary care hospitals (0%-19.1%, 0.85). The regression analysis results indicate that the ACSC admission rate was significantly higher for hospitals than for clinics (
, p<0.05), and for private corporate institutions than public institutions (
, p<0.05). Conclusion: Substantial variations in ACSC admission rates could suggest the potential problem of inefficient use of healthcare resources. Since hospitals and private corporate institutions tend to increase ACSC admission rates, future health policy should focus on these types of institutions.
Regional Disparity of Cardiovascular Mortality and Its Determinants
Kang, Hyeon Jin ; Kwon, Soonman ;
Health Policy and Management, volume 26, issue 1, 2016, Pages 12~23
DOI : 10.4332/KJHPA.2016.26.1.12
Background: Many studies have explained regional disparities in health by socioeconomic status and healthcare resources, focusing on differences between urban and rural area. However some cities in Korea have the highest cardiovascular mortality, even though they have sufficient healthcare resources. So this study aims to confirm three hypotheses. (1) There are also regional health disparities between cities not only between urban and rural area. (2) It has different regional risk factors affecting cardiovascular mortality whether it is urban or rural area. (3) Besides socioeconomic and healthcare resources factors, there are remnant factors that affect regional cardiovascular mortality such as health behavior and physical environment. Methods: The subject of this study is 227 local authorities (si, gun, and gu). They were categorized into city (gu and si consisting of urban area) and non-city (gun consisting of rural area), and the city group was subdivided into 3 parts to reflect relative different city status: city 1 (Seoul, Gyeonggi cities), city 2 (Gwangyeoksi cities), and city 3 (other cities). We compared their mortalities among four groups by using analysis of variance analysis. And we explored what had contributed to it in whole authorities, city and non-city group by using multiple regression analysis. Results: Cardiovascular mortality is highest in city 2 group, lowest in city 1 group and middle in non-city group. Socioeconomic status and current smoking significantly increase mortality regardless of group. Other than those things, in city, there are some factors associated with cardiovascular mortality: walking practice(-), weight control attempt(-), deficiency of sports facilities(+), and high rate of factory lot(+). In non-city, there are other factors different from those of city: obesity prevalence(+), self-perceiving obesity(-), number of public health institutions(-), and road ratio(-). Conclusion: To reduce cardiovascular mortality and it's regional disparities, we need to consider differentiated approach, respecting regional character and different risk factors. Also, it is crucial to strengthen local government's capacity for practicing community health policy.
The Impact of Poverty on Self-Rated Health in Philippines: A Mediated Moderation Model of Health Behaviors and Family and Friend Support
Kim, Jae Woo ; Kim, Dohyeong ; Nam, Eun Woo ;
Health Policy and Management, volume 26, issue 1, 2016, Pages 24~29
DOI : 10.4332/KJHPA.2016.26.1.24
Background: Socio-economical status, represented by poverty, is a potent factor in predicting health status, because preventable illness and death occurs due to poverty and socio-economical situation. This study aims to provide information towards on the correlation between poverty and self-rated health in consideration of elements of health behaviors and family and friend support in Philippines. Methods: Data was collected on 15th to 28th of February 2011 by using structured questionnaire through interview method. Study area is Antipolo and Tondo in Manila, Philippines. Sample size was 1,100 but only 658 cases was analyzed due to incomplete questionnaire. Results: Results show that the poverty has direct negative influence on self-rated health, while the presence of family and friend support decreased negative influence. And through the analysis of mediated moderation model, similarly poverty has also indirect negative effect on self-rated health by health behaviors and family and friend support. Especially, regular exercise was found to be a major variable that mediates poverty and self-rated health. Conclusion: In conclusion, to improve the self-rated health state of respondents need to provide emotional support especially from family and friends. Also regular exercise should be encouraged by raising health awareness through continuous health education and promotion for the residents in order to develop health behaviors.
Spatial Distribution of Diabetes Prevalence Rates and Its Relationship with the Regional Characteristics
Jo, Eun-Kyung ; Seo, Eun-Won ; Lee, Kwang-Soo ;
Health Policy and Management, volume 26, issue 1, 2016, Pages 30~38
DOI : 10.4332/KJHPA.2016.26.1.30
Background: This study purposed to analyze the relationship between spatial distribution of Diabetes prevalence rates and regional variables. Methods: The unit of analysis was administrative districts of city gun gu. Dependent variable was the age- and sex- adjusted diabetes prevalence rates and regional variables were selected to represent three aspects: demographic and socioeconomic factor, health and medical factor, and physical environment factor. Along with the traditional ordinary least square (OLS) regression analysis, geographically weighted regression (GWR) was applied for the spatial analysis. Results: Analysis results showed that age- and sex-adjusted diabetes prevalence rates were varied depending on regions. OLS regression showed that diabetes prevalence rates had significant relationships with percent of population over age 65 and financial independence rate. In GWR, the effects of regional variables were not consistent. These results provide information to health policy makers. Conclusion: Regional characteristics should be considered in allocating health resources and developing health related programs for the regional disease management.
Patient and Hospital Characteristics of Long-Stay Admissions in Long-Term Care Hospitals in Korea
Jeon, Boyoung ; Kim, Hongsoo ; Kwon, Soonman ;
Health Policy and Management, volume 26, issue 1, 2016, Pages 39~50
DOI : 10.4332/KJHPA.2016.26.1.39
Background: This study examined patient and hospital factors related to long-stay admissions in long-term care hospitals (LTCHs) among older people in Korea. Methods: We analyzed health insurance claims data, entitlement data, and institutional administrative data from the National Health Insurance Service databases between 2010 and 2012. At the patient level, we compared characteristics of patients staying in LTCHs for over 180 days (the long-stay group) with those staying in LTCHs for less than 90 days during a calendar year. At the hospital level, we examined the general characteristics and staffing levels of the top 10% of hospitals with the highest proportion of patients whose length of stay (LOS) was 180+ days (the hospitals with long-stay patients) and compared them with the top 10% of hospitals with the highest proportions of patients whose LOS was less than 90 days (hospitals with shorter-stay patients). Results: The long-stay group accounted for about 40% of all LTCH patients. People in the group were more likely to be women, aged 80+, living alone, and experiencing more than two health conditions. Compared to the hospitals with shorter-stay patients, those with long-stay patients were more likely to be occupied by patients with behavior problems and/or impaired cognition, owned by corporate or local governments, have more beds and a longer period of operation, and deliver services with lower staffing levels. Conclusion: This study found long-stay older people in LTCHs and those in LTCHs with high proportions of long-stay older patients had several distinct characteristics compared to their counterparts designated in this study. Patient and hospital characteristics need to be considered in policies aiming to resolve long-stay admissions problems in LTCHs.
Exploratory Study of Publicness in Healthcare Sector through Text Network Analysis
Min, Hye Sook ; Kim, Chang-Yup ;
Health Policy and Management, volume 26, issue 1, 2016, Pages 51~62
DOI : 10.4332/KJHPA.2016.26.1.51
Background: The publicness concept in healthcare has been built to its social consensus relying on historical context, with the result that the meaning of publicness has a great diversity and heterogeneous nature in Korea. Thus it needs to be addressed to clarify the meaning and boundary of the publicness concept in healthcare, so as to discuss its social implication. Methods: In order to investigate whether or how the publicness concept is used in healthcare, we conducted a text network analysis in 779 news articles from 8 Korean daily newspapers over a recent 5-year period. Results: The publicness concept was closely related to medicine and medical institution, and formed a conceptual network with public health, medicine, welfare, patient, government, Jin-ju city, and health. Keywords relating publicness tended to be similar between four major newspapers; however, the association with Jin-ju city, government, and society was noticeable in Kyunghyang Shinmun and Hankyoreh, and so was patient and service in Dong-A Ilbo. Conclusion: Publicness and medicine was closely associated, and government seemed to remain as a main actor for public interest. Publicness was related with a variety of actors and values, with its expanded boundary. The different contexts of publicness by newspapers might reflect each ideological inclination. The textual importance of publicness was relatively low in part, which suggests that publicness was used in a loose sense or as a routine.
Impact of Selective Health Benefit on Medical Expenditure and Provider Behavior: Case of Gastric Cancer Surgery
Cho, Su-Jin ; Ko, Jung-Ae ; Choi, Yeonmi ;
Health Policy and Management, volume 26, issue 1, 2016, Pages 63~70
DOI : 10.4332/KJHPA.2016.26.1.63
Background: Selective health benefit was introduced for decreasing economic burden of patients. Medical devices with economic uncertainty have been covered as selective health benefit by National Health Insurance since December 2013. We aimed to analyze impact of selective health benefit to medical expenditure and provider behavior focused on electrosurgery (ultrasonic shears, electrothermal bipolar vessel sealers) for gastric cancer patients covered since December 2014. Methods: We used the National Health Insurance claims data of 2,698 patients underwent gastric cancer surgery between August 2014 and March 2015. Medical cost and patient sharing per inpatient day were analyzed to verify that covering electrosurgery increased medical expenditure and changed provider behavior from open surgery to endoscopic or laparoscopic surgery. Additionally, we analyzed the claim rate of medical device or goods relating gastric endoscopic and laparoscopic surgery. Results: Medical cost and patient sharing per inpatient day were increased after covering electosurgery as selective health benefit (39,724/1,421 won). However, there were no medical expenditure increases after adjusting claim of electosurgery and patient sharing was decreased 1,057 won especially. The coverage of selective health benefit did not increase the claim rate of medical device or goods related endoscopic or laparoscopic surgery, either. Conclusion: Covering electosurgery decreased patient economic burden and did not change of provider behavior. Expanding selective health benefit is needed to decrease economic burden of severe patients. Further study should evaluate the long term effect with accumulated data.
Comorbidity Adjustment in Health Insurance Claim Database
Kim, Kyoung Hoon ;
Health Policy and Management, volume 26, issue 1, 2016, Pages 71~78
DOI : 10.4332/KJHPA.2016.26.1.71
The value of using health insurance claim database is continuously rising in healthcare research. In studies where comorbidities act as a confounder, comorbidity adjustment holds importance. Yet researchers are faced with a myriad of options without sufficient information on how to appropriately adjust comorbidity. The purpose of this study is to assist in selecting an appropriate index, look back period, and data range for comorbidity adjustment. No consensus has been formed regarding the appropriate index, look back period and data range in comorbidity adjustment. This study recommends the Charlson comorbidity index be selected when predicting the outcome such as mortality, and the Elixhauser's comorbidity measures be selected when analyzing the relations between various comorbidities and outcomes. A longer look back period and inclusion of all diagnoses of both inpatient and outpatient data led to increased prevalence of comorbidities, but contributed little to model performance. Limited data range, such as the inclusion of primary diagnoses only, may complement limitations of the health insurance claim database, but could miss important comorbidities. This study suggests that all diagnoses of both inpatients and outpatients data, excluding rule-out diagnosis, be observed for at least 1 year look back period prior to the index date. The comorbidity index, look back period, and data range must be considered for comorbidity adjustment. To provide better guidance to researchers, follow-up studies should be conducted using the three factors based on specific diseases and surgeries.
Health in All Policies: The Evolution of Health Promotion and Intersectoral Cooperation
Jhang, Won Gi ;
Health Policy and Management, volume 26, issue 1, 2016, Pages 79~91
DOI : 10.4332/KJHPA.2016.26.1.79
'Health in All Policies' is a new strategy for governance for health in 21st century. The evolution of health promotion has affected the creation of the strategy through the efforts to tackle health inequalities by addressing social determinants of health. More concern about health inequalities, involving wider policy areas, and higher level of institutionalization distinguish the strategy from the old intersectoral collaboration such as intersectoral action for health and healthy public policy. Making intersectoral collaboration the mainstream of policy making is important to address integrated policy agendas such as 'Health in All Policies' and 'Sustainable Development Goals.' Political leadership and interpersonal skills are also required to strengthen the capacity of public health sector for implementing 'Health in All Policies' in local, national, and international circumstances.