Health Status and Health Service Utilization: Barriers and Facilitators for Korea Medicaid Beneficiaries

PURPOSE: This study compares beneficiaries of Korean Medicaid with those under the National Health Insurance program, seeking to understand how each group utilizes their healthcare. METHODS: Data were obtained from a Health Promotion Survey in 2005. Health status was measured by the respondents' perception of health. Health service utilization included the availability of healthcare services, the type of healthcare institution, and intent to revisit. Predisposing and enabling factors, as well as health care needs were used for this study. RESULTS: Compared to National Health Insurance beneficiaries, Medicaid beneficiaries reported lower levels of health status and fewer enabling factors. They had more chronic diseases and disabilities. Education level, existence of chronic diseases, exercise patterns, and disabilities were associated with health status. CONCLUSION: We found that Medicaid beneficiaries had fewer resources and higher levels of health needs. As Medicaid is reformed, policy makers and administrators should understand healthcare utilization behaviors of Medicaid beneficiaries and the factors hindering access to care.

Effect of An Education Program on the Pregnant Women to Improve the Correct Recognition and Choice among the BCG Vaccination Methods / 한국역학회지

PURPOSE: The most effective and basic Tb preventive measure is BCG vaccination. Even though the Intradermal vaccination method in BCG vaccination is known to be the most accurate method in preventing the advanced Tb, nowdays most of the Korean civilian hospitals utilize multipuncture BCG vaccination method ,which is quite contrary to the national standard intradermal vaccination method. Therefore I decided to inform and educate the pregnant women who would be in a position to choose the BCG vaccination method. This will help them understand the BCG vaccination methods properly. We should urge the intradermal method which is acknowledged as the national standard vaccination method. METHODS: The questionnaire was mailed twice to 214 pregnant women requring the antenatal care who visited any of the 9 health centers in Busan from the period of Aug to Oct. 2007. The 1st questionnaire was done in 214 pregnant women prior to education concerning the BCG vaccination methods and Tb, and the 2nd questionnaire was done after education. Contents of the questionnaire were general knowledges for BCG vaccination method, intention of selection for BCG vaccination, knowledges for the adverse effect, etc. Data analysis was performed utilizing SPSS (ver12) and the pregnant women's change in concept was comparatively analyzed with percentage, chi-square -test . RESULTS: Considering the general characteristics of the pregnant women who participated in the study, the highest percentage was noticed in their 15-28 gestational weeks (60.8%), Age over 30 (70.1%), Education level-college graduate (76.6%). Recognition to the presence of two types BCG vaccination method was 27.6% before education and 95.3% after education which showed a marked improvement (p=0.0001). After education, 82.2% of pregnant women decided to choose intradermal BCG vaccination method at birth which was 23.4% before education (p=0.0003). Despite the fact that intradermal BCG method is the national standard vaccination method, some of them prefer multipuncture BCG vaccination method, because most of the scars (41.3%), the civilian hospitals do it (35.7%), because of the lack of the education and information from the health centers and public institutions (17.4%). The future selection of BCG vaccination methods as follows: before education, intradermal BCG vaccination 31.0%, multipuncture BCG vaccination 14.6%, uncertain 54.4%, and after education, intradermal BCG vaccination 72.4%, multipuncture BCG vaccination 2.8%, uncertain 24.8% (p<0.0001). CONCLUSIONS: The pregnant women were not fully aware of intradermal and multipuncture BCG vaccination methods. Through education and information, it was possible for them to thoroughly recognize the BCG vaccination methods. In order to urge the intradermal BCG vaccination method, the health centers and public institutions need to educate and inform the pregnant women regarding the intradermal BCG vaccination method which is the standard vaccination method in Korea.