Journal of Preventive Medicine and Public Health

Original Articles

Determinants of Health Care Expenditures and the Contribution of Associated Factors: 16 Cities and Provinces in Korea, 2003-2010: Kimyoung Han, Minho Cho, Kihong Chun; J Prev Med Public Health. 2013;46(6):300-308. Published online November 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.6.300

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Objectives

The purpose of this study was to classify determinants of cost increases into two categories, negotiable factors and non-negotiable factors, in order to identify the determinants of health care expenditure increases and to clarify the contribution of associated factors selected based on a literature review.

Methods

The data in this analysis was from the statistical yearbooks of National Health Insurance Service, the Economic Index from Statistics Korea and regional statistical yearbooks. The unit of analysis was the annual growth rate of variables of 16 cities and provinces from 2003 to 2010. First, multiple regression was used to identify the determinants of health care expenditures. We then used hierarchical multiple regression to calculate the contribution of associated factors. The changes of coefficients (R²) of predictors, which were entered into this analysis step by step based on the empirical evidence of the investigator could explain the contribution of predictors to increased medical cost.

Results

Health spending was mainly associated with the proportion of the elderly population, but the Medicare Economic Index (MEI) showed an inverse association. The contribution of predictors was as follows: the proportion of elderly in the population (22.4%), gross domestic product (GDP) per capita (4.5%), MEI (-12%), and other predictors (less than 1%).

Conclusions

As Baby Boomers enter retirement, an increasing proportion of the population aged 65 and over and the GDP will continue to increase, thus accelerating the inflation of health care expenditures and precipitating a crisis in the health insurance system. Policy makers should consider providing comprehensive health services by an accountable care organization to achieve cost savings while ensuring high-quality care.

Summary

Citations

Citations to this article as recorded by

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Medical Care Utilization During 1 Year Prior to Death in Suicides Motivated by Physical Illnesses: Jaelim Cho, Won Joon Lee, Ki Tae Moon, Mina Suh, Jungwoo Sohn, Kyoung Hwa Ha, Changsoo Kim, Dong Chun Shin, Sang Hyuk Jung; J Prev Med Public Health. 2013;46(3):147-154. Published online May 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.3.147

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Abstract PDF

Objectives

Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses.

Methods

Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status.

Results

Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p=0.021) after adjustment for residence, socioeconomic status, and morbidity.

Conclusions

Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.

Summary

Citations

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English Abstract

Subjective Satisfaction with Medical Care among Older People: Comprehensiveness, General Satisfaction and Accessibility.: Hwa Joon Kim, Young Koh, Eun Jeong Chun, Soong Nang Jang, Chang Yup Kim; J Prev Med Public Health. 2009;42(1):35-41.; DOI: https://doi.org/10.3961/jpmph.2009.42.1.35

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Abstract PDF

OBJECTIVES
The changing population age structure and rapidly increasing medical costs make providing high-quality, effective medical care for the elderly a challenge. This study assessed the satisfaction with medical care in terms of comprehensiveness, general satisfaction, and accessibility among community-dwelling Korean elders. METHODS: Data were obtained from a nationwide representative sample of the older adults(aged 65 years old or older) living in the community, who participated in a 2006 telephone survey conducted using random digit dialing (n=881). General satisfaction, comprehensiveness and accessibility were measured using a 10-item satisfaction survey questionnaire. Descriptive analysis was used to assess the distribution of each of three components of subjective satisfaction. Analysis of covariance (ANCOVA) was used to examine the association of each of the three components with socioeconomic variables. RESULTS: Comprehensiveness and general satisfaction were low among older people with a high socioeconomic status. Accessibility was evaluated as low among older people of low socioeconomic status, those living in rural areas and those who were medical aid beneficiaries. CONCLUSIONS: Urgent interventions should be considered in order to improve accessibility to medical care for elders of low socioeconomic status and those living in rural communities. Given the rapid aging of the population, we need to develop a monitoring system to improve the quality of geriatric care.

Summary

Citations

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Optimization and Adjustment of Multilevel Medical Facilities for the Elderly from the Perspective of Accessibility
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The Gap Between Physicians and the Public in Satisfaction with the National Health Insurance System in Korea
Kye-Hyun Kim, Eun-Cheol Park, Myung-Il Hahm
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The Rehabilitation Services Utilization of People with Disabilities in a Rural Area
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Original Articles

A Study on the Medical Insurance Utilization of Workers Suffering from Low Back Pain in an Area.: Chul Gab Lee, Hyun Ok Ahn, So Yeon Ryu, Jong Park, Ki Soon Kim, Yang Ok Kim; Korean J Prev Med. 1997;30(4):764-778.

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Abstract PDF: To find the medical insurance utilization of workers when suffering from low back pain, an analysis was made toward the data of medical insurance benefits matched with the general characteristics of 10,183 workers, who were registered continuously from 1993 to 1995 at a medical insurance cooperation for industrial workers. The results were as follows; 1. The period prevalence of the medical insurance utilization for low back pain for 3 years from 1993 to 1995 was calculated as 17.1% for male workers and 19.4% for female workers. Most common cause of utilization was other dorsopathies including the herniation of lumbar discs. 2. The utilization rate increased significantly as the present age and the age joining the company got older(p<0.001). As the duration of employment got longer, the utilization rate of the male showed the tendency to increase and that of the female increased significantly(p<0.05). Among male workers employed at cement and concrete manufacturing companies showed higher utilization rate and among female laborers showed significantly higher utilization rate than clerical workers(p<0.01). 3. Annual utilization rate for low back pain didn't show any difference, but the portion of other dorsopathies among cause of utilization showed the tendency to increase from 1993 to 1995. 4. The mean number of claims for outpatient medical care for low back pain differed significantly by age, working duration, type of industries, income level(p<0.05), and the mean of total visiting days for care of low back pain differed siginificantly by working duration. In conclusion, considering the fact that the medical insurance utilization for low back pain increased annually and other dorsopathies including the herniation of dorsopathies were increasing, an effective preventive or management program for low back pain toward worker employed at industries were required.; Summary

Trend of Medical Care Utilization and Medical Expenditure of the Elderly Cohort.: Kyeong Soo Lee, Pock Soo Kang; Korean J Prev Med. 1997;30(2):437-461.

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Abstract PDF: Because of a significant improvement in the economic situation and development of scientific techniques in Korea during the last 30 years, the life expectancy of the Korean people has lengthened considerably and as a result, the number of the elderly has markedly increased. Such an increase of the number of aged population brought about many social, economic, and medical problems which were never seriously considered before. This study was conducted to assess the trend of medical care utilization and medical expenditure of the elderly. The data of each patient in the study were taken from computer database maintained for administrative purpose by the Korea Medical Insurance Corporation. The study population was 132,670 who were 60 years old or more and registered in Korean Medical Insurance Corporation from 1989 to 1993. The study subjects were predominantly female(56.3%) and 10,000-20,000 Won premium group(50.6%). The following are summaries of findings : The total increase of the number of inpatient cases was 40.5% from 1989 through 1993. The average annual increase was 3.7% in inpatient medical expenditures per case, 4.4% in inpatient medical expenditures per day and 0.08% in length of stay per case from 1989 through 1993. Cataract was the most prevalent disease of 10 leading frequent diseases in all ages from 1989 through 1993. The case mix in 1993 compared to 1989 revealed that cataract and ischemic cerebral disease were increased whereas essential hypertension and pulmonary tuberculosis were decreased. The average annual increase of medical expenditures was 3.8% in general hospitals, 6.3% in hospitals and 2.4% in clinics. From 1989 through 1993, medical expenditures used by high-cost patients accounted for about 14% to 20% of all expenditures for inpatient care, while they represented less than 2.5% of the elderly population. Time series analysis revealed that total medical expenditures and doctor's fee for inpatient will be progressively increased whereas drug expenditures for inpatient will be decreased. And there will be no change in length of stay. Based on the above results, the factors increasing medical cost and utilization should be identified and the method of cost containment for the elderly health care should be developed systematically.; Summary

Relationship between structural characteristics and hospital mortality rates on tertiary referral hospitals in Korea.: Tae Yong Sohn, Seung Hum Yu; Korean J Prev Med. 1996;29(2):279-294.

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Abstract PDF: This study was to evaluate hospital characteristics as composition of manpower and facilities to the death rate of patient; and to earmark the factors affecting the overall hospital mortality rates. The data utilized were derived from survey material conducted by the Korean Hospital Association on 32 tertiary referral hospitals in Korea between 1986 and 1994. The findings are: 1. Those hospitals having the most capacity per bed had little difference to the mortality rates than the others. 2. Those hospitals having the most daily patients per specialist had significantly higher mortality rates than the others, but the number of daily patients per nurse had little effect on the mortality rates. 3. Those hospitals which had a relatively sufficient number of quality assurance activities revealed a lower mortality, and particularly in case where such effort was directed to the clinicians, the outcome was remarkable. we concluded that the major factor affecting the hospital mortality rates seems to be the number of specialists per number of beds, the degree of quality assurance assessment of the clinicians, the quality assurance activities of each hospital as a whole, and the number of daily patient per specialist. According to the findings of this study, the composition and quality of specialist and adequate quality assurance activities seemed to be the essential for the improvement of hospital care. Therefore, in this regard the proper implementation of policy and support is highly recommended. Due to lack of available research material, the personal characteristics of specialists haven't been considered in this study However, this longitudinal observation of 32 tertiary referral hospitals over a nine year period has significant merit alone.; Summary

Effects of Regional Medical Insurance on Utilization of Medical Care in Urban Population.: Seok Beom Kim, Pock Soo Kang; Korean J Prev Med. 1994;27(1):117-134.

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Abstract PDF: The effects of regional medical insurance on utilization of medical care in urban population was examined in this study. The data was collected in a 2-year follow-up household survey conducted at Taegu city before and after implementation of the regional medical insurance. The study population was divided into 2 groups. Cohort I was the uninsured in 1989 and cohort II was the insured in 1989. After the coverage of medical insurance, physician visit rate per 1,000 population, use-disability ratio and use-restricted activity ratio in cohort I were increased compared to cohort II in both of acute and chronically ill people. The use-disability ratio and use-restricted activity ratio of the insured poor were lower than those of the insured nonpoor in both of cohort I and cohort II. The major reasons for pharmacy use were accessibility and affordability before the coverage of medical insurance in cohort I, however, after the coverage of medical insurance, the important reason was accessibility rather than affordabifity. In logistic regression analysis of physician visit, the significant independent variables were acute illness episode(+), chronic illness episode(+) and income(+) in both of cohort I and cohort II. In cohort I, after the coverage of medical insurance, more people replied that the medical cost of hospital and clinic was reasonable. The people who covered by the regional medical insurance were more dissatisfied with the imposed premium than those who covered by other types of medical insurance in both of cohort I and cohort II. More people in cohort II than cohort I were dissatisfied with the services from hospitals and clinics after implementation of the regional medical insurance. In conclusion. after the coverage of medical insurance, the gap between the poor and the nonpoor still exists in terms of medical care utilization.; Summary

Geographical distribution of physician manpower by specialty and care level.: Seung Hum Yu, Sang Hyuk Jung, Byung Yool Cheon, Tae Yong Shn, Hyohn Joo Oh; Korean J Prev Med. 1993;26(4):661-671.

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Abstract PDF: In order to compare the geographical distribution of physician by level of medical care and specialty, a log linear model was applied to the annual registration data of the Korean Medical Association as of the end of December, 1991 which was supplemented from related institutions and adjusted with relevant sources. Those physicians in primary and secondary care institutions were not statistically significantly unevenly distributed by province-level catchment area. There were some differences in physician distribution among big cities, medium and small-sized cities, and counties; however, those physicians for primary care level were equitably distributed between cities and counties. Specialties for secondary care physicians were less evenly distributed in county areas than in city areas, and generalists are distributed more evenly in cities and counties than in big cities. There is a certain limitation due to underregistration in the annual physician registration to the Korean Medical Association; however, the geographical distribution of physicians has been improved quantitatively. It is strongly suggested that specialties and the level of medical care should be considered for further physician manpower studies.; Summary

A study on the practice variations according to physician characteristics.: Eun Kyeong Jeong, Ok Ryun Moon, Chang Yup Kim; Korean J Prev Med. 1993;26(4):614-627.

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Abstract PDF: It is well known that a physician's personal characteristic affects his practice pattern. Furthermore, a physician's specialty has powerful influences on his practice pattern. However, despite the fact specialization has received the most attention for its influence on physician's service behavior, few studies have been conducted on the variations of contents and volume of physician's services. This study has intended to identify factors influencing the practice variations according to various physician characteristics. There are some other evidences that medical care providers are different in using of health services and resources in Korea. Four physician characteristics were selected for the analysis, two demographical factors, age and sex, and two practice factors, place of practice and medical specialty. Also, three indicators of service amount(total amount of insurance claim bill, number of visits per case, number of prescriptions per case) were selected. From the pool of insurance claims for ambulatory care received by the Korean National Federation of Medical Insurance(NFMI), 84,898 cases were randomly sampled. In the meantime using physician database of NFMI, 613 general practitioners(GP), 107 regular family physicians(FP), 483 'grandfather' family physicians(GFP), and 1,157 specialist practitioners(SP) were randomly sampled. Their different practice contents were compared concerning the specialty, age groups, sex, and practice sites(urban-rural). Specialist physicians tend to provide more costly care than do generalists. General practitioners and family physicians usually make fewer following visits and prescriptions. Age is also the important factor in determining the amount of services, which is highest at the physician's age group of 40's. Female doctors and urban practitioners use much more resources than their counterparts respectively. Research findings suggest that physician's characteristics particularly the specialty can affect practice patterns and resource utilizations. Other characteristics such as age and sex are not controllable but physician's specialty is relatively easily controllable during the entire phases of policy implementation. This is all the more true in the individual's initial decision of his specialty. Specialization therefore should receive policymaker's attention for its potential influence on medical care utilization and health care expenditure.; Summary

Recognition and attitude to fundtional division between physicians and pharmacists of practising physicians and pharmacists in Taegu city.: Moo Sik Lee, Nung Ki Yoon, Suk Kwon Suh, Jae Yong Park; Korean J Prev Med. 1993;26(1):1-19.

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Abstract PDF: Mail questionnaire was administrated to 370 practising physicians and 388 pharmacists in Taegu city selected by systematic sampling to examine utilization states and opinion of pharmacy under medical care insurance programme and the attitude to the functional division between physicians and pharmacists from April to May 1992. Regarding the opinion on the outcome of drug-store under medical insurance, 71.2 percent of practicing physician answered failure but 13.4 percent of practicing pharmacists answered failure in contrast. Fifty percent of practicing physician asserted introducing functional division between physician and pharmacist while 66.9 percent of practicing pharmacist answered drug-store under medical insurance itself is successful programme. Average daily numbers of preparation of medicine was 32.2 case. Percentage of utilization of drug-store under medical insurance to average daily cases of preparing of medicine was 20 percent, percentage of utilization with physician's prescription was 0.7 percent. And 58.7 percent of practicing physician experienced outside the institute prescription. Regarding the opinion on the pros and cons of enforcing functional division between physician and pharmacist, 59.2 percent of practicing physician preferred pros and 17.7 percent cons ,but 38 percent of practicing pharmacist preferred pros and 45.5 percent cons. And pharmacist know better the content of functional division between physician and pharmacist, practicing emphasized to prevent misuse or abuse of medicine but practicing pharmacist emphasized to display physician and pharmacist's professional ability. And as an opinion on implementation style of functional division between physician and pharmacist in pros respondents, practicing physician favored mandatory enforcement (52.3%), while practicing pharmacist favored partial incomplete functional division (81.7%). As the method of prescription if functional division between physician and pharmacist will be enforced, both practicing physician and pharmacist preferred generic name (44.0%, 89%) mostly, but physician preferred brand name (35.3%) secondly. Regarding the reason for not implementing functional division between physician and pharmacist up to date, both physician and pharmacist answered problem of business right between physician and pharmacist, followed by lack of recognition, and interest of people and lack of the governmental willness. Regarding the opinion on prior decision of condition for enforcing functional division between physician and pharmacist, practicing physician and pharmacist named uneven distribution of medical facilities and drug-store between rural and urban, inequality of physician and pharmacist manpower and the problem of manpower demand and supply mostly, and practicing physician pointed out establishing attitude of acceptance on the part of pharmacist and practicing pharmacist favored establishing attitude of acceptance on the part of physician, which was different attitudes between physician and pharmacist. Following conclusion was reached; 1. Current drug-store under medical insurance program yield insufficient outcome, so we should consider program conversion from drug-store under medical insurance program to functional division between physician and pharmacist. 2. There were problem of business right and conflicts between physician and pharmacist at enforcing functional division between physician and pharmacist, so the government should search for formulating plan to resolve the problem and have neutral willness for the protection of the national health.; Summary

The Projection of Medical Care Expenditure in View of Population Age Change.: Seung Hum Yu, Sang Hyuk Jung, Jeung Mo Nam, Hyohn Joo Oh; Korean J Prev Med. 1992;25(3):303-311.

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Abstract PDF: It is very important to estimate the future medical care expenditure, because medical care expenditure escalation is a big problem not only in the health industry but also in the Korean economy today. This study was designed to project the medical care expenditure in view of population age change. The data of this study were the population projection data based on National Census Data (1990) of the National Statistical Office and the Statistical Reports of the Korea Medical Insurance Corporation. The future medical care expenditure was eatimated by the regression model and the optional simulation model. The significant results are as follows; 1. The future medical care expenditure will be 3,963 billion Won in the year 2000, 4,483 billion Won in 2010, and 4,826 billion Won in 2020, based on the 1990 market price considering only the population age change. 2. The proportion of the total medical care expenditure in the elderly over 65 will be 10. 4% in 2000, 13.5% in 2010, and 16.9% in 2020. 3. The future medical care expenditure will be 4,306 billion Won in the year 2000, 5,1101 billion Won in 2010, and 5, 699 billion Won in 2020 based on the 1990 market price considering the age structure change and the change of the case-cost estimated by the regression model. 4. When we consider the age-structure change and inflation compared with the preceding year, the future medical care expenditurein 2020 will be 21 trillion Won based on a 5% inflation rate, 42 trillion Won based on a 7.5% inflation rate, and 84 trillion Won based on a 10% inflation rate. Consideration of the aged (65 years old and over)will be essential to understand the acute increase of medical care expenditure due to changes in age structure of the population. Therefore, alternative policies and programs for the caring of the aged should be further studied.; Summary

A Study on the Criteria for Selection of Medical Care Facilities.: Woo Hyun Cho, Han Joong Kim, Sun Hee Lee; Korean J Prev Med. 1992;25(1):53-63.

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Abstract PDF: There are increasing interest and need for information on health care consumer with the significance of hospital marketing and strategic planning being increasingly emphasized. This study was conducted to investigate the criteria for selection of medical facilities according to the characteristics of health care consumer by the types of medical services on a sample of 1,500 population aged 20 years and above. Major findings are as follows; 1. When considering the criteria for selection of medical facilities into two factors, namely, quality or convenience factors, convenience factor was the major contributor for outpatient and dental services whereas it was quality factor for inpatient services. 2. Females and those residing in large cities selected medical facilities based on convenience factor in the outpatient services. In the case of inpatient service, persons who considered their present health status to be good and whose ages were 50 years old and above choose medical facilities based on quality factor. 3. Persons who considered medical facilities to be profit-making tended to choose medical facilities based on convenience factor for outpatient services. There were no differences in the cases of inpatient and dental services. 4. There was no significant difference on the criteria for selection of medical facilities according to the decision maker for selection or trust on medical facilities. On the use of health service information, selection of medical facilities was based on qPality factor for those who made more use of the information in the cases of outpatient and dental services. 5. Analysis using the logistic regression model on the criteria for the selection of medical facilities with the characteristics of health care consumer as independent variables was performed. The selection of medical facilities was significantly related with residential area, sex, and use of information on medical facilities for outpatient services and with age, average monthly income, and perception of health status for inpatient services. For dental services significant association with residential area and use of information on medical facilities was seen. The results of this study, despite some limitations, can be used as baseline data for marketing and strategic planning of hospital management.; Summary

An Evaluative Analysis of the Referral System for Insurance Patients.: Dalsun Han, Byungyik Kim, Youngjo Lee, Sangsoo Bae, Soonho Kwon; Korean J Prev Med. 1991;24(4):485-495.

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Abstract PDF: This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discourag - ing the use of to Vii; ry care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131(3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care uti lization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from. that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.; Summary

Health status and medical care utilization patterns of rural aged.: Jang Kyun Oh; Korean J Prev Med. 1991;24(3):328-338.

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Abstract PDF: To find out the state of illness, patterns of medical care utilization, and factors which determine medical care utilization for aged we surveyed 679 rural old persons who live in the Chungnam province from Jan. 10 1991 to Jan. 19. The major findings of this study were as follows; 1. The morbidity rate of chronic illness during last 3 months was 56.4% for all surveyed old persons; 58.7% for female and 52.8% for male. 2. As expected, 80 years old or above group showed the highest morbidity rate, 60.2% and the 65-69 years age group was the lowest, 50.5%. 3. Old persons who are householder, whose family income is less than 290,000 won per month, and who receive benefits from the public medical assistance program had relative higher morbidity rate than other groups and the difference was statistically significant (P<0.05). 4. The most frequent chronic illness was musculoskeletal disease, 49.6%; the disease from which the aged had suffered for the longest period was gastrointestinal, 11.6yrs; the cerebrovascular was the disease which inflicts the lowest level of physical ability. 5. 67.1% of 383 persons who were suffering from chronic illness were in need of medical care but unmet; among the remaining 32.9% who utilized medical care, 19.2% utilized it in local clinics or hospital OPD and 15% in the health centers of subcenters. 6. Old person who are married, whose sons are householder and whose family income is 500,000 won or above per month showed relative higher utilization rate than other groups and the difference was statistically significant (P<0.05). 7. The most common reason why the aged did not utilize, in spite of, need medical care was economic problem, 35.4%. For the aged whose family income per month is 500,000 won or above, however the most common reason was tolerable symptom, 46.9% while persons who answered economic problem were 6.1% of them, the lowest frequency.; Summary

The study for recent changes of disease-mix in health insurance data.: Seung Hum Yu, Sang Hyuk Jung; Korean J Prev Med. 1990;23(3):345-357.

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Abstract PDF: Accumulated data on medical care utilization among the insured in Korea Medical Insurance Corporation can explain the health status of the population. The purpose of this study was to analyze a change of the disease-mix and utilization pattern by controlling the size of the population enrollment. Major findings of the study are as follows: 1. The changes of inpatient disease-mix a. Utilization rate was 139.2% in 1988 against 1980. b. Disease groups higher than the average utilization rate included neoplasms, endocrine, nutritional and metabolic diseases and immunity disorders, mental disorders etc. Meanwhile, disease groups seen less often were infections and parasistic diseases, diseases of bloodforming, diseases of the digestive system etc. c. Utilization rate was up 106.3% in 1988 compared to 1985, and diseases above that average level were ill-defined intestinal infections, chronic liver disease and cirrhosis, diabetes mellitus, essential hypertension, etc. d. The disease-mix by institution in 1988 compared to 1985 shows that chronic disorders rank high in general hospitals whereas opthalmologic, obstetric, and orthopedic diseases rank high in private clinics. 2. The changes of outpatient disease-mix a. Utilization rate was up 175.2% in 1988 compared to 1980. b. Disease groups higher than the average utilization rate included neoplasms, endocrine, nutritional and metabolic diseases and immunity disorders, mental disorders etc. And disease groups seen less often were infections and parasistic diseases, diseases of the respiratory system, diseases of the genitourinary system. etc. c. Utilization rate was up 104.0% in 1988 compared to 1985, and diseases above that average level were gastric ulcer, diseases of hard tissues of teeth, etc. And diseases seen below that average level were acute nasopharyngitis (common cold), acute upper respiratory infections of multiple or unspecified sites, etc. It was concluded that medical care utilization level was increased, and that, from 1980 to 1988, disease-mix shifted to the chronic disorders. Chronic disorders accounted for more medical care utilization in general hospitals.; Summary

A Study on the Regional Self-sufficiency for In-patient Care Services.: Dal Sun Han, Soon Ho Kwon; Korean J Prev Med. 1990;23(3):285-295.

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Abstract PDF: The utilization of medical care services has been partly regionalized with the implementation of referral requirement by the government since July 1, 1989 when the health insurance coverage was extended to all the people. For the purpose of regionalization, the whole country has been primarily divided into tertiary care regions, and each of them again into secondary care regions. This study investigates the self-sufficiency for in-patient care services of secondary care regions focusing on why it varies among the regions. In doing so, analysis is performed to examine a model which embodies three sets of hypotheses as follows: 1) The regional self-sufficiency for medical care services would be subject to direct influences of regional characteristics, amount of available services and structural properties of regional medical care system ; 2) The regional characteristics would have indirect effects on the self-sufficiency which are mediated by medical care services ; and 3) The amount of available services would indirectly affect the self-sufficiency by influencing the structure of regional medical care system. The results of analysis were generally consistent with the model. The findings have some practical implications. The regional self-sufficiency for medical care services partly depends upon basic properties of each region which cannot be changed in a short period of time. Thus the self-sufficiency for medical care services can be improved by health policy measure. In some of the regions the self-sufficiency for in-patient care services was much higher or lower than can be predicted from the bed-population ratio. Indication is that the allocation of health resources should be made considering a variety of factors bearing upon the supply of and demand for health care ; not on the basis of just a single criterion like the availability. The self-sufficiency of a certain region is related to not only its own characteristics but also the characteristics of neighboring regions. Therefore, attention should be also directed to the inter-regional relationships in health care when the needs for investment of health resources in a region are assessed. However, it should be noted that this study used the data collected before the referral requirement was imposed. A replication of this analysis using recent data would provide an evaluation of the impact on the self-sufficiency of the referral requirement as well as a confirmation of the findings of this study.; Summary

Change in Medical Care Utilization over Time in Early Years of Insurance Coverage.: Byoung Yik Kim, Youngjo Lee, Dal Sun Han; Korean J Prev Med. 1990;23(2):185-193.

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Abstract PDF: The purpose of this study is to observe the pattern of change in medical care utilization over time in early years of insurance coverage. The source of data is the benefit records file of a voluntary medical insurance society for covering the four-year period, from 1982 to 1985. The measure of medical care utilization used in this study is the age-sex standardized percentage of the enrollee who have visited a physician over total analytical population during a three-month period. For six cohorts by the year of enrollment (1979-1984), the relationship between the utilization and duration of insurance coverage was examined controlling for the calender year and season. In the analysis, logistic multiple regression and residual analysis were employed. It was observed that medical care utilization rapidly increased during the early stage of insurance coverage, and after then increased at a slower rate over time to become almost stable in about twenty months.; Summary

Analysis of Sports Medical Care Utilization during the 24th Seoul Olympic Games.: Seung Hum Yu, Myongsei Sohn, Young Doo Lee, Eun Cheol Park, Chun Bae Kim; Korean J Prev Med. 1989;22(1):136-145.

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Abstract PDF: This study made a descriptive analysis of the cumulative amount and rate of sports medical care utilization during the 24th Seoul Olympic Games by the participating athletes, officials, etc. The sports medical care utilization was a component of the total medical care use and was basically caused by the prevention and treatment of sports injuries. The analytic data were derived from the Olympic Health Management Information System (OHMIS) of the SLOOC and the Korea Athlete Trainer Association(KATA). These were analyzed according to the., quantity of physician visits and the utilization rate, which was the amount of utilization divided by the total number of participating persons. The results were as follows: Firstly, the sports medical care utilization by the persons participating in the Seoul Olympics amounted to 17.9 % of the total medical care utilization. The venue medical services utilization accounted for 54.7 % of the total physician visits, which was larger than the village medical center's utilization. The number of physician visits per hundred persons during the 2 week period in the venue clinic was 3.03 and that of the village medical center was 2.51, therefore, the total was 5.54. Secondly, athletes accounted for 82.3% and officials 12.2% in the sports medical care utilization by participants. These results were because athletes, who were directly related to the games, called extremely often on the physicians. The utilization rate of sports medical care by athletes was 34.29. Thirdly, the sports medical demand according to type of therapy could be ranked from high to low in the following order: sports massage, thermal therapy, and electrical stimulation treatment, etc. The department of physical therapy in the village medical center was used a great deal. Fourthly, the trend of daily sports medical care utilization by the athletes showed a bell shape centering around the opening day of the Seoul Olympic Games. The utilization rate of athletes was 2.3; however, that of officials was 0.6. Lastly, the sports medical demand was calculated according to the continents, and Central America, Africa and Middle-East Asia proved to have a higher rate of sports medical care utilization than the more powerful and industrialized continent or regions.; Summary

Comparision of medical care utilization between newly detected hypertensive patients and known hypertensive patients.: Byung Yool Cheon; Korean J Prev Med. 1988;21(1):47-60.

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Abstract PDF: The monthly ambulatory treatment days in newly detected hypertensive group and known hypertension group were analyzed. The population was identified through the records of screening examination given by Korea Medical Insurance Corporation during the period from April to July, 1986. From the records of screening examination, 11,614 hypertensive patients were identified. By random sampling, 959 patients were selected ; among them, 554 fell under the category of known hypertension group and the other 415 fell under the newly detected hypertension group. The monthly ambulatory treatment days of theses patients during the period from the April, 1985 to September, 1987 were analyzed in order to compare the exents of medical care utilization as well as to define and analyze the determinants responsible for the ambulatory treatment days between the two groups. The following results were obtained. 1) In the known hypertension group, no statistically significant changes in the ambulatory treatment days was observed after, in comparison to before, the screening examination. However, in the newly detected hypertension group the medical care utilization increased after the screening examination because of hypertension. 2) The ambulatory treatment days for hypertension of the known hypertension was statistically significant and higher than that of the newly detected hypertension group after screening examination. 3) There was no statistically significant change in the ambulatory treatment days in association with diseases other than hypertension in either group before and after the screening examination. 4) There was no statistically significant change in the ambulatory treatment days in the known hypertension group. However, the income was a statistically significant variable in the newly detected hypertension group. 5) After the screening examination, the variables determining the ambulatory treatment days were the age of the patient and the diastolic blood pressure in the known hypertension group. These variables responsible for 2.02% of the total ambulatory treatment days. In the newly detected hypertension group, the income was a statistically significant variable which was responsible for 2.10% of total ambulatory treatment days. The above results satisfied the hypothesis that there would be no significant changes in the ambulatory treatment days before and after the screening examination in the known hypertension group. Also the hypothesis that there would be no significant change in the exents of medical care utilization for the diseases other than hypertension before and after the screening examination in either group was satisfied. Also the medical care utilization was significantly higher in the known hypertension group than the newly detected hypertension group after the screening examination. This finding satisfied the hypothesis. This study was limited by the lack of considering fully the variables responsible for the clinical symptoms of hypertension as well as for the individual characteristics. Thus, the result of this study are not fully adequate to define the determinants responsible for the exents of medical care utilization. In the future studies on medical care utilization, additional variables should be considered.; Summary

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