ABSTRACT
Background@#Unmet healthcare needs have many advantages for measuring inequalities in healthcare use. However, the existing indicator is difficult to capture the reality of unmet healthcare needs sufficiently and is not quite appropriate in comparing regional inequality. The purpose of this study is to critically analyze the utilization of the unmet healthcare need indicator for regional healthcare inequalities research. @*Methods@#We used the level of healthcare accessibility and healthcare need to categorize the regions that are known to cause differences in healthcare utilization between regions and verified how existing unmet healthcare need indicator is distributed at the regional level. @*Results@#Four types of regions were classified according to the high and low levels of healthcare needs and accessibility. The hypothesis about the regional type expected to have the highest unmet healthcare need was not proved. The hypothesis about the lowest expected regional type was proved, but the difference in the average rate of unmet healthcare needs among regional types was not significant. The standard deviation of the rate of unmet healthcare needs among regions within the same type was also higher than the overall regional variation, which also disproved the whole frame of hypothesis. @*Conclusion@#Failure to prove the hypothesis means the gap between the supposed meaning of the indicator and the reality. In order to understand the current state of healthcare utilization of people in various regions of Korea and to resolve inequality, fundamental research on the in-depth structure and mechanisms of healthcare utilization is needed.
ABSTRACT
BACKGROUND: Due to the asymmetry of information and knowledge and the power of bureaucrats and medical professionals, it is not easy for citizens to participate in health care policy making. This study analyzes the case of the insured organization participating in the Health Insurance Policy Committee (HIPC) and provides a basis for discussing methods and conditions for better public participation. METHODS: Qualitative analysis was conducted using the in-depth interviews with the participants and document data such as materials for HIPC meetings. Semi-structured interviews were conducted with purposively sampled six participants from organizations representing the insured in HIPC. The meanings related to the factors affecting participation were found and categorized into major categories. RESULTS: The main factors affecting participating in the decision making process were trust and cooperation among the participants, structure and procedure of governance, representation and expertise of participants, and contents of issues. Due to limited cooperation, participants lacked influence in important decisions. There was an imbalance in power due to unreasonable procedures and criteria for governance. As the materials for meetings were provided inappropriate manner, it was difficult for participants to understand the contents and comments on the meeting. Due to weak accountability structure, opinions from external stakeholders have not been well received. The participation was made depending on the expertise of individual members. The degree of influence was different depending on the contents of the issues. CONCLUSION: In order to meet the values of democracy and realize the participation that the insured can demonstrate influence, it is necessary to have a fair and reasonable procedure and a sufficient learning environment. More deliberative structure which reflects citizen's public perspective is required, rather than current negotiating structure of HIPC.