Journal of Preventive Medicine and Public Health

Special Article

National Cancer Control Plan of the Korea: Current Status and the Fourth Plan (2021-2025): Kyu-Tae Han, Jae Kwan Jun, Jeong-Soo Im; J Prev Med Public Health. 2023;56(3):205-211. Published online May 31, 2023; DOI: https://doi.org/10.3961/jpmph.23.115

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Cancer management has become a major policy goal for the government of the Korea. As such, the government introduced the National Cancer Control Plan (NCCP) to reduce the individual and social burdens caused by cancer and to promote national health. During the past 25 years, 3 phases of the NCCP have been completed. During this time, the NCCP has changed significantly in all aspects of cancer control from prevention to survival. The targets for cancer control are increasing, and although some blind spots remain, new demands are emerging. The government initiated the fourth NCCP in March 2021, with the vision of “A Healthy Country with No Concerns about Cancer Anywhere at Any Time,” which aims to build and disseminate high-quality cancer data, reduce preventable cancer cases, and reduce gaps in cancer control. Its main strategies include (1) activation of cancer big data, (2) advancement of cancer prevention and screening, (3) improvement in cancer treatment and response, and (4) establishment of a foundation for balanced cancer control. The fourth NCCP has many positive expectations, similar to the last 3 plans; however, cross-domain support and participation are required to achieve positive results in cancer control. Notably, cancer remains the leading cause of death despite decades of management efforts and should continue to be managed carefully from a national perspective.

Summary

Korean summary
- 기존 1~3차 국가암관리계획의 전반적인 성과를 소개합니다. - 제4차 국가암관리계획의 목표 및 내용을 기존 계획과 비교하여 설명합니다.

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Association between Socioecological Status, Nutrient Intake, and Cancer Screening Behaviors in Adults Aged 40 and Over: Insights from the Eighth Korea National Health and Nutrition Examination Survey (KNHANES, 2019)
Seungpil Jeong, Yean-Jung Choi
Nutrients.2024; 16(7): 1048. CrossRef

Perspective

Gender in Climate Change: Safeguarding LGBTQ+ Mental Health in the Philippine Climate Change Response From a Minority Stress Perspective: Rowalt Alibudbud; J Prev Med Public Health. 2023;56(2):196-199. Published online March 13, 2023; DOI: https://doi.org/10.3961/jpmph.22.501

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Abstract PDF

Climate-related events unevenly affect society, worsening mental health disparities among vulnerable populations. This paper highlights that lesbians, gays, bisexuals, transgender, queers, and other individuals identifying as sexual and gender minorities (LGBTQ+) could be considered a climate-vulnerable population in the Philippines, one of the most climate-vulnerable countries. As such, this paper elucidated that LGBTQ+ Filipinos can be marginalized in climate response efforts due to their sexual orientation and gender minority identities. According to the minority stress theory, discrimination against LGBTQ+ individuals may predispose them to mental health problems. Thus, there is a need to institute an LGBTQ+ inclusive mental health response for climate-related events to address discrimination against LGBTQ+ individuals and uphold their mental health.

Summary

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A human rights‐based approach to climate injustices at the local, national, and international levels: Program and policy recommendations
Sheri R. Levy, Meroona Gopang, Luisa Ramírez, Allan B. I. Bernardo, Martin D. Ruck, Anni Sternisko
Social Issues and Policy Review.2024; 18(1): 3. CrossRef
Improving LGBTQ+ mental health in Southeast Asia through social work: Insights from the Philippines
Rowalt Alibudbud
International Social Work.2024;[Epub] CrossRef
Leveraging critical race theory to produce equitable climate change adaptation
Kieren Rudge
Nature Climate Change.2023; 13(7): 623. CrossRef
Mental health service, training, promotion, and research during typhoons: Climate change experiences from the Philippines
Rowalt Alibudbud
Asian Journal of Psychiatry.2023; 86: 103673. CrossRef
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Original Article

Social and Policy Determinants of COVID-19 Infection Across 23 Countries: An Ecological Study: Kyungsik Kim, Young-Do Jeung, Jeoungbin Choi, Sue K. Park; J Prev Med Public Health. 2022;55(2):144-152. Published online February 10, 2022; DOI: https://doi.org/10.3961/jpmph.21.396

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Abstract Summary PDF Supplementary Material

Objectives
This study aimed to identify the social and policy determinants of coronavirus disease 2019 (COVID-19) infection across 23 countries.
Methods
COVID-19 indicators (incidence, mortality, and fatality) for each country were calculated by direct and indirect standardization. Multivariable regression analyses were used to identify the social and policy determinants of COVID-19 infection.
Results
A higher number of doctors per population was related to lower incidence, mortality, and fatality rates of COVID-19 in 23 countries (β=-0.672, -0.445, and -0.564, respectively). The number of nurses/midwives per population was associated with lower mortality and fatality rates of COVID-19 in 23 countries (β=-0.215 and -0.372, respectively). Strengthening of policy restriction indicators, such as restrictions of public gatherings, was related to lower COVID-19 incidence (β=-0.423). A national Bacillus Calmette–Guérin vaccination policy conducted among special groups or in the past was associated with a higher incidence of COVID-19 in 23 countries (β=0.341). The proportion of the elderly population (aged over 70 years) was related to higher mortality and fatality rates (β=0.209 and 0.350, respectively), and income support was associated with mortality and fatality rates (β=-0.362 and -0.449, respectively).
Conclusions
These findings do not imply causality because this was a country-based correlation study. However, COVID-19 transmission can be influenced by social and policy determinants such as integrated health systems and policy responses to COVID-19. Various social and policy determinants should be considered when planning responses to COVID-19.

Summary

Korean summary
본 연구는 23개국의 코로나 19 감염 지표 (발생, 사망, 치명)과 관련있는 사회적, 정책적 요소를 확인하고자 하는생태학적 연구이다. 이는 코로나 19 감염 지표에 대한 인과성을 제시하는 연구가 아니기에 주의 깊은 해석이 필요하며 본 연구에서 제시한 사회적, 정책적 요소를 통해 코로나 19 감염에 대한 국가적인 정책을 고려할 수 있을 것으로 기대된다.

Citations

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COVID 19 mortality as a reflection of the quality of health in EU countries
Beáta Stehlíková, Zuzana Vincúrová, Ivan Brezina, Ilona Švihlíková
Economics & Sociology.2023; 16(3): 138. CrossRef
Social and Policy Determinants of COVID-19
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
Journal of Preventive Medicine and Public Health.2022; 55(3): 307. CrossRef
Social and Policy Determinants of COVID-19 Infection Across 23 Countries: An Ecological Study
Kyungsik Kim, Sue K. Park
Journal of Preventive Medicine and Public Health.2022; 55(3): 308. CrossRef
Country-level and regional COVID-19 burden and determinants across OECD member states and partner countries
Nlandu Roger Ngatu, Kazuto Tayama, Kanae Kanda, Tomohiro Hirao
Environmental Health and Preventive Medicine.2022; 27: 41. CrossRef
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Epidemiology and Health.2022; 44: e2022087. CrossRef

Special Articles

Measuring Trends in the Socioeconomic Burden of Disease in Korea, 2007-2015: Tae Eung Kim, Ru-Gyeom Lee, So-Youn Park, In-Hwan Oh; J Prev Med Public Health. 2022;55(1):19-27. Published online January 31, 2022; DOI: https://doi.org/10.3961/jpmph.21.594

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Abstract Summary PDF Supplementary Material

This study estimated the direct and indirect socioeconomic costs of 238 diseases and 22 injuries from a social perspective in Korea from 2007 to 2015. The socioeconomic cost of each disease group was calculated based on the Korean Standard Disease Classification System. Direct costs were estimated using health insurance claims data provided by the National Health Insurance Service. The numbers of outpatients and inpatients with the main diagnostic codes for each disease were selected as a proxy indicator for estimating patients’ medical use behavior by disease. The economic burden of disease from 2007 to 2015 showed an approximately 20% increase in total costs. From 2007 to 2015, communicable diseases (including infectious, maternal, pediatric, and nutritional diseases) accounted for 8.9-12.2% of the socioeconomic burden, while non-infectious diseases accounted for 65.7-70.7% and injuries accounted for 19.1-22.8%. The top 5 diseases in terms of the socioeconomic burden were self-harm (which took the top spot for 8 years), followed by cirrhosis of the liver, liver cancer, ischemic heart disease, and upper respiratory infections in 2007. Since 2010, the economic burden of conditions such as low back pain, falls, and acute bronchitis has been included in this ranking. This study expanded the scope of calculating the burden of disease at the national level by calculating the burden of disease in Koreans by gender and disease. These findings can be used as indicators of health equality and as useful data for establishing community-centered (or customized) health promotion policies, projects, and national health policy goals.

Summary

Korean summary
2007년에서 2015년 기간의 건강보험 자료 등을 이용하여, 해당기간의 경제적 질병부담을 측정하였으며, 해당 기간동안 경제적 질병부담은 20%의 증가를 나타내었다. 동 기간동안 비감염성 질환의 경제적 질병부담의 비율은 약 70%로 나타났으며, 감염성 질환은 약 10%, 손상은 20%로 나타났다. 한편 개별 질병군 기준으로는 자살을 포함한 자해가 1위를 차지한 해가 가장 많았다.

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Katarzyna Helon, Małgorzata Wisłowska, Krzysztof Kanecki, Paweł Goryński, Aneta Nitsch-Osuch, Krzysztof Bonek
Journal of Clinical Medicine.2024; 13(2): 602. CrossRef
Assessment and nonsurgical management of low back pain: a narrative review
Sung Cheol Park, Min-Seok Kang, Jae Hyuk Yang, Tae-Hoon Kim
The Korean Journal of Internal Medicine.2023; 38(1): 16. CrossRef
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Wonbin Choi, Hyunji Koo, Kyeong Hye Jeong, Eunyoung Kim, Seung-Hun You, Min-Taek Lee, Sun-Young Jung
Korean Journal of Clinical Pharmacy.2023; 33(3): 168. CrossRef
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Estimated trends in hospitalizations due to occupational injuries in Korea based on the Korean National Hospital Discharge In-depth Injury Survey (2006-2019)
Seong-Uk Baek, Won-Tae Lee, Min-Seok Kim, Myeong-Hun Lim, Jin-Ha Yoon
Epidemiology and Health.2023; 45: e2023042. CrossRef

Measuring the Burden of Disease in Korea, 2008-2018: Yoon-Sun Jung, Young-Eun Kim, Hyesook Park, In-Hwan Oh, Min-Woo Jo, Minsu Ock, Dun-Sol Go, Seok-Jun Yoon; J Prev Med Public Health. 2021;54(5):293-300. Published online September 30, 2021; DOI: https://doi.org/10.3961/jpmph.21.478

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Abstract Summary PDF Supplementary Material

The study aims to examine the current status and differences in the burden of disease in Korea during 2008-2018. We calculated the burden of disease for Koreans from 2008 to 2018 using an incidence-based approach. Disability adjusted life years (DALYs) were expressed in units per 100 000 population by adding years of life lost (YLLs) and years lived with disability (YLDs). DALY calculation results were presented by gender, age group, disease, region, and income level. To explore differences in DALYs by region and income level, we used administrative district and insurance premium information from the National Health Insurance Service claims data. The burden of disease among Koreans showed an increasing trend from 2008 to 2018. By 2017, the burden of disease among men was higher than that among women. Diabetes mellitus, low back pain, and chronic lower respiratory disease were ranked high in the burden of disease; the sum of DALY rates for these diseases accounted for 18.4% of the total burden of disease among Koreans in 2018. The top leading causes associated with a high burden of disease differed slightly according to gender, age group, and income level. In this study, we measured the health status of Koreans and differences in the population health level according to gender, age group, region, and income level. This data can be used as an indicator of health equity, and the results derived from this study can be used to guide community-centered (or customized) health promotion policies and projects, and for setting national health policy goals.

Summary

Korean summary
이 논문에서는 장애보정생존년수라는 지표를 활용하여 2008-2018년 한국인의 질병부담 산출결과를 제시하였으며, 성별·연령군별·질환별 질병부담 수준의 차이 뿐만 아니라 지역 및 소득수준의 사회경제적 수준에 따른 질병부담의 격차도 함께 제시하였다.

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The National Health Plan 2030: Its Purpose and Directions of Development: Yumi Oh; J Prev Med Public Health. 2021;54(3):173-181. Published online May 7, 2021; DOI: https://doi.org/10.3961/jpmph.21.198

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Abstract Summary PDF

The National Health Plan 2030 (HP2030) started to be prepared in 2017 and was completed and announced in December 2020. This study presents an overview of how it was established, the major changes in policies, its purpose, and future directions. This study analyzed the steps taken in the past 4 years to establish HP2030 and reviewed major issues at the international and governmental levels based on an evaluation of HP2020 and its content. HP2030 establishes 6 divisions and 28 topic areas, and it will continue to expand investments in health with a total budget of 2.5 trillion Korean won. It also established goals to enhance health equity for the first time, with the goal of calculating healthy life expectancy in a way that reflects the circumstances of Korea and reducing the gap in income and healthy life expectancy between regions. The establishment of HP2030 is significant in that it constitutes a sustainable long-term plan with sufficient preparation, contains policy measures that everyone participates in and makes together, and works towards improvements in universal health standards and health equity. With the announcement of HP2030, which includes goals and directions of the national health policy for the next 10 years, it will be necessary to further strengthen collaboration with relevant ministries, local governments, and agencies in various fields to concretize support for prevention-centered health management as a national task and to develop a health-friendly environment that considers health in all policy areas.

Summary

Korean summary
본 연구는 지난 17년부터 4년간 준비한 국민건강증진종합계획2030이 발표됨에 따라 수립경과와 주요 변화정책을 분석하고, 수립의 의의를 검토하여 향후 추진방향을 제시하고자 한다. 국민건강증진종합계획2030의 수립은 충분한 준비기간을 통한 지속가능한 중장기 계획의 수립, 모든 사람에 함께 참여하고 만들어가는 정책으로서의 전환, 보편적인 건강수준 향상과 건강형평성 제고를 했다는데 그 의의가 있다 향후 10년간의 국가 건강정책의 목표와 방향을 담은 HP2030 발표를 계기로, 모든 정책 영역에서 건강을 고려하는 건강친화적 환경 구축을 위해 관련 부처와 지자체, 다양한 분야의 주체들과 협력을 강화해야 하겠다.

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COVID-19: Special Article

Mainstreaming of Health Equity in Infectious Disease Control Policy During the COVID-19 Pandemic Era: Hongjo Choi, Seong-Yi Kim, Jung-Woo Kim, Yukyung Park, Myoung-Hee Kim; J Prev Med Public Health. 2021;54(1):1-7. Published online January 15, 2021; DOI: https://doi.org/10.3961/jpmph.20.593

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Abstract Summary PDF

The Korean government’s strategy to combat coronavirus disease 2019 (COVID-19) has focused on non-pharmaceutical interventions, such as social distancing and wearing masks, along with testing, tracing, and treatment; overall, its performance has been relatively good compared to that of many other countries heavily affected by COVID-19. However, little attention has been paid to health equity in measures to control the COVID-19 pandemic. The study aimed to examine the unequal impacts of COVID-19 across socioeconomic groups and to suggest potential solutions to tackle these inequalities. The pathways linking social determinants and health could be entry points to tackle the unequal consequences of this public health emergency. It is crucial for infectious disease policy to consider social determinants of health including poor housing, precarious working conditions, disrupted healthcare services, and suspension of social services. Moreover, the high levels of uncertainty and complexity inherent in this public health emergency, as well as the health and socioeconomic inequalities caused by the pandemic, underscore the need for good governance other than top-down measures by the government. We emphasize that a people-centered perspective is a key approach during the pandemic era. Mutual trust between the state and civil society, strong accountability of the government, and civic participation are essential components of cooperative disaster governance.

Summary

Korean summary
"이 연구는 코로나19 대유행이 건강불평등에 미치는 영향을 검토하고, 불평등 완화 방안을 제시하고자 한다. 건강의 사회적 결정요인은 코로나19와 건강불평등을 이해하기 위한 출발점이다. 건강의 사회적 결정요인은 코로나19 감염과 그로 인한 사망 등 직접영향 경로와 코로나19 대응과정의 문제로 건강불평등을 야기하는 간접영향 경로에 모두 관여한다. 공중보건위기로 인한 건강불평등을 줄이기 위해서는 시민참여를 통한 협력적 거버넌스 강화와 모든 건강정책에서 사람중심돌봄의 관점을 견지하는 것이 필요하다."

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COVID-19: Perspective

A Hidden Key to COVID-19 Management in Korea: Public Health Doctors: Sejin Choi; J Prev Med Public Health. 2020;53(3):175-177. Published online April 14, 2020; DOI: https://doi.org/10.3961/jpmph.20.105

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Abstract PDF

Public health doctors of Korea contributed significantly to massive coronavirus disease 2019 (COVID-19) testing. They were immediately dispatched to epicenters of the COVID-19 pandemic, and have run tests at screening centers, airport quarantines and hospitals. However, their expertise from in-field experience has been often neglected. It is time to reorganize public health doctor system to better prepare for future epidemics. Transforming and strengthening their roles as public health experts through systematic training is crucial.

Summary

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Climate Change: Review

Research Trends in Agenda-setting for Climate Change Adaptation Policy in the Public Health Sector in Korea: Su-Mi Chae, Daeeun Kim; J Prev Med Public Health. 2020;53(1):3-14. Published online January 31, 2020; DOI: https://doi.org/10.3961/jpmph.19.326

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Abstract Summary PDF Supplementary Material

Many studies have been conducted to assess the health effects of climate change in Korea. However, there has been a lack of consideration regarding how the results of these studies can be applied to relevant policies. The current study aims to examine research trends at the agenda-setting stage and to review future ways in which health-related adaptation to climate change can be addressed within national public health policy. A systematic review of previous studies of the health effects of climate change in Korea was conducted. Many studies have evaluated the effect of ambient temperature on health. A large number of studies have examined the effects on deaths and cardio-cerebrovascular diseases, but a limitation of these studies is that it is difficult to apply their findings to climate change adaptation policy in the health sector. Many infectious disease studies were also identified, but these mainly focused on malaria. Regarding climate change-related factors other than ambient temperature, studies of the health effects of these factors (with the exception of air pollution) are limited. In Korea, it can be concluded that studies conducted as part of the agenda-setting stage are insufficient, both because studies on the health effects of climate change have not ventured beyond defining the problem and because health adaptation to climate change has not been set as an important agenda item. In the future, the sharing and development of relevant databases is necessary. In addition, the priority of agenda items should be determined as part of a government initiative.

Summary

Korean summary
이 연구는 한국에서 수행된 기후변화에 따른 건강영향 연구의 동향을 살펴봄으써, 기후변화 건강 적응이 보건 정책의 어젠다로 자리 잡기 위한 연구 방향을 검토했다. 향후 국가는 기후변화 적응을 위한 우선순위 건강 문제를 검토해야 하며, 관련된 연구의 양과 질을 확보해 국가 전략의 기초가 될 수 있도록 해야 한다.

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Original Articles

Cancer Patients’ Utilization of Tertiary Hospitals in Seoul Before and After the Benefit Expansion Policy: Sanghyun Cho, Youngs Chang, Yoon Kim; J Prev Med Public Health. 2019;52(1):41-50. Published online January 4, 2019; DOI: https://doi.org/10.3961/jpmph.18.166

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Abstract Summary PDF Supplementary Material

Objectives
The aim of this study was to investigate cancer patients’ utilization of tertiary hospitals in Seoul before and after the benefit expansion policy implemented in 2013.
Methods
This was a before-and-after study using claims data of the Korean National Health Insurance Service from 2011 to 2016. The unit of analysis was inpatient episodes, and inpatient episodes involving a malignant neoplasm (International Classification of Diseases, Tenth Revision codes: C00-C97) were included in this study. The total sample (n=5 565 076) was divided into incident cases and prevalent cases according to medical use due to cancer in prior years. The tertiary hospitals in Seoul were divided into two groups (the five largest hospitals and the other tertiary hospitals in Seoul).
Results
The proportions of the incident and prevalent episodes occurring in tertiary hospitals in Seoul were 34.9% and 37.2%, respectively, of which more than 70% occurred in the five largest hospitals in Seoul. Utilization of tertiary hospitals in Seoul was higher for inpatient episodes involving cancer surgery, patients with a higher income, patients living in areas close to Seoul, and patients living in areas without a metropolitan city. The utilization of the five largest hospitals increased by 2 percentage points after the policy went into effect.
Conclusions
The utilization of tertiary hospitals in Seoul was concentrated among the five largest hospitals. Future research is necessary to identify the consequences of this utilization pattern.

Summary

Korean summary
2014년부터 2016년까지 암 발생자 입원의 34.9%가 서울 소재 상급종합병원에서 이루어졌으며, 그중 73.9%가 5대 상급종합병원에서 이루어졌다. 4대 중증질환 보장성 강화 정책 후에 암환자의 서울 소재 상급종합병원 이용은 6.1%(2% 포인트) 증가하였으며, 5대 상급종합병원 이용률은 증가(정책 전: 23.6%, 정책 후: 25.8%), 그 외 서울 소재 상급종합병원 이용률은 감소하였다(정책 전: 9.3%, 정책 후: 9.1%).

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Public Participation in the Process of Local Public Health Policy, Using Policy Network Analysis: Yukyung Park, Chang-yup Kim, Myoung Soon You, Kun Sei Lee, Eunyoung Park; J Prev Med Public Health. 2014;47(6):298-308. Published online November 11, 2014; DOI: https://doi.org/10.3961/jpmph.14.029

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Abstract PDF: Objectives
To assess the current public participation in-local health policy and its implications through the analysis of policy networks in health center programs.
Methods
We examined the decision-making process in sub-health center installations and the implementation process in metabolic syndrome management program cases in two districts (‘gu’s) of Seoul. Participants of the policy network were selected by the snowballing method and completed self-administered questionnaires. Actors, the interactions among actors, and the characteristics of the network were analyzed by Netminer.
Results
The results showed that the public is not yet actively participating in the local public health policy processes of decision-making and implementation. In the decision-making process, most of the network actors were in the public sector, while the private sector was a minor actor and participated in only a limited number of issues after the major decisions were made. In the implementation process, the program was led by the health center, while other actors participated passively.
Conclusions
Public participation in Korean public health policy is not yet well activated. Preliminary discussions with various stakeholders, including civil society, are needed before making important local public health policy decisions. In addition, efforts to include local institutions and residents in the implementation process with the public officials are necessary to improve the situation.; Summary

Special Article

Burden of Disease in Japan: Using National and Subnational Data to Inform Local Health Policy: Stuart Gilmour, Yi Liao, Ver Bilano, Kenji Shibuya; J Prev Med Public Health. 2014;47(3):136-143. Published online May 30, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.3.136

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Abstract PDF

The Global Burden of Disease (GBD) study has been instrumental in guiding global health policy development since the early 1990s. The GBD 2010 project provided rich information about the key causes of mortality, disability-adjusted life years, and their associated risk factors in Japan and provided a unique opportunity to incorporate these data into health planning. As part of the latest update of this project, GBD 2013, the Japanese GBD collaborators plan to update and refine the available burden of disease data by incorporating sub-national estimates of the burden of disease at the prefectural level. These estimates will provide health planners and policy makers at both the national and prefectural level with new, more refined tools to adapt local public health initiatives to meet the health needs of local populations. Moreover, they will enable the Japanese health system to better respond to the unique challenges in their rapidly aging population and as a complex combination of non-communicable disease risk factors begin to dominate the policy agenda. Regional collaborations will enable nations to learn from the experiences of other nations that may be at different stages of the epidemiological transition and have different exposure profiles and associated health effects. Such analyses and improvements in the data collection systems will further improve the health of the Japanese, maintain Japan's excellent record of health equity, and provide a better understanding of the direction of health policy in the region.

Summary

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Original Article

Health Impact Assessment of Free Immunization Program in Jinju City, Korea: Keon Yeop Kim, So Youn Jeon, Man Joong Jeon, Kwon Ho Lee, Sok Goo Lee, Dongjin Kim, Eunjeong Kang, Sang Geun Bae, Jinhee Kim; J Prev Med Public Health. 2012;45(4):267-275. Published online July 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.4.267

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Abstract PDF

Objectives

This study was conducted to assess the potential health impacts and improve the quality of the free immunization program in Jinju City by maximizing the predicted positive health gains and minimizing the negative health risks.

Methods

A steering committee was established in September 2010 to carry out the health impact assessment (HIA) and began the screening and scoping stages. In the appraisal stage, analysis of secondary data, a literature review, case studies, geographic information systems analysis, a questionnaire, and expert consultations were used. The results of the data collection and analyses were discussed during a workshop, after which recommendations were finalized in a written report.

Results

Increased access to immunization, comprehensive services provided by physicians, the strengthened role of the public health center in increasing immunization rates and services, and the ripple effect to other neighboring communities were identified as potential positive impacts. On the other hand, the program might be inaccessible to rural regions with no private clinics where there are more at-risk children, vaccine management and quality control at the clinics may be poor, and vaccines may be misused. Recommendations to maximize health gains and minimize risks were separately developed for the public health center and private clinics.

Conclusions

The HIA provided an opportunity for stakeholders to comprehensively overview the potential positive and negative impacts of the program before it was implemented. An HIA is a powerful tool that should be used when developing and implementing diverse health-related policies and programs in the community.

Summary

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English Abstract

The Proposal of Policies Aimed at Tackling Health Inequalities in Korea.: Tae Ho Yoon; J Prev Med Public Health. 2007;40(6):447-453.; DOI: https://doi.org/10.3961/jpmph.2007.40.6.447

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Abstract PDF

Although the New National Health Promotion Plan 2010 target to reduce health inequalities, whether the program will be effective for reducing the health inequalities in Korea remains quite unclear. More and more developed countries have been started to concentrate on comprehensive policies for reducing health inequalities. The health policies of the UK, Netherlands, and Sweden are the most wellknown. I propose that a comprehensive blueprint for tackling health inequalities in Korea should be made and that it must contain five domains: a target, structure and process, life-course approach, area-based approach, and reorganization of health care resources. The target should be based on determinants of health and more attention should be paid to socioeconmic factors. The structure and process require changes from the national health care policy based on medical services to the national health policy that involves the establishment of a Social Deputy Prime Minister and the strengthening multidisciplinary action. A life-course approach especially focused on the early childhood years. Area-based approach such as the establishment of healthy communities, healthy schools, or healthy work-places which are focused on deprived areas or places is also required. Finally, health care resources should be a greater investment on public resources and strengthening primary care to reduce health inequalities. The policy or intervention studies for tackling health inequalities should be implemented much more in Korea. In addition, it is essential to have political will to encoruage policy action.

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Original Article

Impacts of Implementation of Patient Referral System in terms of Medical Expenditures and Medical Utilization.: Sang Hyuk Jung, Han Joong Kim; Korean J Prev Med. 1995;28(1):207-224.

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Abstract PDF: A new medical delivery system which regulated outpatient department(OPD) use from tertiary care hospitals was adopted in 1989. Under the new system, patients using tertiary care hospital OPD without referral slip from clinics or hospital could not get any insuranced benefit for the services received from the tertiary care hospital. This study was conducted to evaluate the Patient Referral System(PRS) with respect to health care expenditures and utilization. Two data sets were used in this study. One was monthly data set(from January 1986 to December 1992)from the Annual Report of Korea Medical Insurance Corporation(KMIC). The other was monthly joint data set composed of personal data of which 10% were selected randomly with their utilization data of KMIC from January 1988 to December 1992. The data were analyzed by time-series intervention model of SAS-ETS. The results of this study were as follows: 1. There was no statistically significant changes in per capita expenditures following PRS. 2. Utilization episodes per capita was increased statistically significantly after implementation of PRS. The use of clinics and hospitals increased significantly, whereas in tertiary care hospitals the use decreased significantly immediately after implementation of PRS and increased afterwards. 3. Follow-up visits per episode were decreased statistically significantly after implementation of PRS. The decrease of follow-up visits per episode were remarkable in clinics and hospitals, whereas in tertiary care hospitals it was increased significantly after implementation of PRS. 4. There was no statistically significant changes in prescribing days per episode following PRS. Futhermore, clinics and hospitals showed a statistically significant decrease in prescribing days per episode, whereas in tertiary care hospital it shower statistically significant increase after implementation of PRS. 5. Except high income class, the use of tertiary care hospitals showed statistically significant decrease after implementation of PRS. The degree of decrease in the use of tertiary card hospitals was inversely proportional to income. These results suggest that the PRS policy was not efficient because per capita expenditures did not decrease, and was not effective because utilization episodes per capita, follow-up visits per episode, and prescribing days per episode were not predictable and failed to show proper utilization. It was somewhat positive that utilization episodes per capita were decreased temporarily in tertiary card hospitals. And PRS policy was not appropriate because utilization episodes per capita was different among income groups. In conclusion, the PRS should be revised for initial goal attainment of cost containment and proper health care utilization.; Summary

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