Changes in Health Care Utilization during the COVID-19 Pandemic / 보건행정학회지

Background@#After the first case of coronavirus disease 2019 (COVID-19) in January 2020, Korea has experienced three waves in 2020. This study aimed to analyze changes in health care utilization according to the period of the 1st to 3rd waves of the COVID-19 pandemic. @*Methods@#We analyzed 3,354,469,401 national health insurance claims from 59,104 medical facilities between 2017 and 2020.Observed-to-expected ratios (O:E ratio) with data from 2017 to 2019 as expected values and data from 2020 as observed values were obtained to analyze changes in medical utilization. T-test was used to test whether the difference of observed and expected values was statistically significant. @*Results@#In 2020, the O:E ratio was 0.894, indicating a decrease in health care utilization overall during the pandemic. The O:E ratio of the 1st wave was 0.832, which was lower than those of the second (0.886) and third (0.873) waves. Health care utilization decreased relatively more among outpatient, women, children and adolescents, and health insurance patients. And health care utilization decreased more in small medical facilities and in Daegu and Gyeongbuk during the first wave. During the pandemic, the O:E ratios of respiratory diseases were 0.486-0.694, while chronic diseases and mental diseases were more than 1.0. @*Conclusion@#Health care utilization decreased during the COVID-19 pandemic overall, and there were differences by COVID-19 waves, and by the characteristics of patients and medical facilities. It is necessary to understand the cause of changes in health care utilization in order to cope with the prolonged COVID-19 pandemic.

2018 Current Health Expenditures and National Health Accounts in Korea / 보건행정학회지

This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2018 constructed according to the SHA2011, which is a manual for System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analyzing health accounts of OECD member countries. Particularly, scale and trends of the total CHE financing as well as public-private mix are parsed in depth. In the case of private financing, estimation of total expenditures for (revenues by) provider groups (HP) is made from both survey on the benefit coverage rate of National Health Insurance (by National Health Insurance Service) and Economic Census and Service Industry Census (by National Statistical Office); and other pieces of information from Korean Health Panel Study, etc. are supplementarily used to allocate those totals into functional classifications. CHE was 144.4 trillion won in 2018, which accounts for 8.1% of Korea's gross domestic product (GDP). It was a big increase of 12.8 trillion won, or 9.7%, from the previous year. GDP share of Korean CHE has already been close to the average of OECD member countries. Government and compulsory schemes' share (or public share), 59.8% of the CHE in 2018, is much lower than the OECD average of 73.6%. ‘Transfers from government domestic revenue’ share of total revenue of health financing was 16.9% in Korea, lower than the other social insurance countries. When it comes to ‘compulsory contributory health financing schemes,’ ‘transfers from government domestic revenue’ share of 13.5% was again much lower compared to Japan (43.0%) and Belgium (30.1%) with social insurance scheme.

Patient assessment of primary care under the Designated Practice Scheme for Medical Aid beneficiaries, using the Korean Primary Care Assessment Tool (K-PCAT): a district of Seoul, South Korea

To control excessive utilization of medical care services by Medical Aid beneficiaries (MABs), the Korean government has introduced the Designated Practice Scheme (DPS, July 2007). The purpose of this study was to assess the primary care quality of the DPS using the Korean Primary Care Assessment Tool (K-PCAT). Data were collected from the survey (2008-2009) of MABs who had to designate a community clinic as the first contact practice obligatorily in one district of Seoul. Among all eligible (n=164), we analyzed the data of 154 beneficiaries, excluding those who did not meet the K-PCAT criteria of a usual source of care. Primary care quality under the DPS was poor (58.1 points) on a 100-point scale, compared with those previously studied under the Korean health care system. More seriously it was very poor (48.9 points) in MABs without intention to continue participation in the DPS, who were 50% of all participants. Among 5 domains of the K-PCAT, comprehensiveness (44.7 points) and coordination (39.3 points) were lower in score than other domains, comparable to previous studies, representing the reality of primary care in South Korea. Primary care quality was better in MABs using primary care practices including general practice, family medicine, and internal medicine instead of other specialty practice groups (60.2 vs. 53.9 points, P=0.015), and in MABs with longer duration (> or =3 vs. <3 years) since the first visit (59.7 vs. 51.9 points, P=0.010). These patterns were maintained after multivariate analysis, controlling for confounding variables. This research suggests that a complete overhaul of the scheme itself, such as the introduction of pay-for-performance method, etc., is necessary to improve primary care quality of the DPS.

Trends in Avoidable Death over 20 Years in Korea

To evaluate the achievement of health care services in Korea independent of other socioeconomic factors, we observed the time trend of avoidable death between 1983 and 2004. A list of avoidable causes of death was constructed based on the European Community Atlas of ''Avoidable Death''. We calculated sex- and agestandardized mortality rates of Korean aged 1-64 yr using data of the Korea National Statistical Office. The avoidable mortality rate (per 100,000 persons) decreased from 225 to 84 in men and from 122 to 41 in women. Accordingly, the proportion of avoidable deaths among all classifiable deaths was reduced by 8.1% in men and 6.4% in women. However, mortality rates from some preventable causes such as ischemic heart disease and malignant neoplasms of lung, breast, cervix, and colorectum have been on the rise. Mortality preventable by appropriate medical care showed the greatest reduction (by 77.8%), while the mortality preventable by primary prevention showed the least reduction (by 50.0%). These findings suggest that health care service has significantly contributed to the improvement of health in Korea. However, more effective intervention programs would be needed given the less reduction in mortality avoidable by primary or secondary prevention than expected and unexpectedly increasing mortality from several preventable causes.

A Cotwin Control Study of Smoking and Risk Factors of Metabolic Syndrome

BACKGROUND: Smoking effects are relatively well-documented, especially on cancers and cardiovascular diseases. However, the direction and magnitude of association between smoking and obesity remain unclear. Conflicting results so far are thought to stem from the multiple confounding structure of smoking and other obesogenic life style characteristics. METHODS: Cotwin control study is a genomic epidemiology design, in which the other twin (=cotwin) serves as a control of the twin. Cotwin control study, discordant for smoking habits can provide powerful evidence of association between smoking and obesity by completely matching genomic information, intrauterine environment, and almost all environmental factors. We selected 3,697 like-sex twin pairs (2,762 male and 935 female pairs) out of 63,666 pairs of adult twins in the existing Korea Twin and Family Register, whose smoking habits are discordant. We used the information of obesity as body mass index (BMI, kg/m2), blood pressure, and blood cholesterol level at the time or later than the smoking information. Paired t-test was done to compare the smoking effects. RESULTS: Lifetime smoking rate was 80.1% (47.9 current smoker) for men and 10% (1.7% current smoker) for women. Among 2,762 and 935 male and female like-sex twin pairs, 363 male pairs and 20 female pairs correspond to the definition of smoker-nonsmoker pair. The male smokers demonstrated increase in BMI by 0.47, while female smokers show slight decrease (by 0.13), which were not statistically significant. Diastolic and systolic blood pressure, and cholesterol level were slightly increased among smokers by 1.85 mmHg,0.62 mmHg, and 1.28 mg/dl for men. For women, the results show increase in diastolic blood pressure (3.42mmHg) and cholesterol level (1.25 mg/dl), and systolic pressure (8.17 mmHg). CONCLUSION: The results refute the possibility that smoking can reduce BMI. Considering the direct adverse effect of smoking, it should be emphasized that smoking do not decrease obesity and thus increase overall metabolic syndrome.