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Background@#On October 1, 2017, a new coinsurance reduction policy for children under 15 was introduced to minimize the lack of inpatient medical services for economic reasons and secure children’s access to medical care. @*Methods@#This study analyzes the effect of this coinsurance reduction policy on healthcare utilization using data from the National Health Insurance Service-National Sample Cohort between 2015 and 2019. Groups were classified by 3 case groups and a control group according to age. The dependent variables were inpatient cost, admission, length of hospitalization, outpatient cost and visit, and total cost. The difference-in-differences method was used to examine changes in healthcare utilization among the case and control groups after policy implementation. @*Results@#Children of the age group 1–5 exhibited an increase in inpatient services and a decrease in outpatient services. There was a 16.17% increase in inpatient cost, 8.55% increase in inpatient admission, 10.67% increase in inpatient length of hospitalization, −9.14% decline in outpatient cost, and −6.79% decline in outpatient visits. Regarding children in the age groups of 6–10 and 11–15, the effect of the policy was inconclusive. @*Conclusion@#The reduction in coinsurance rate policy in hospitalization among children has increased inpatient services and reduced outpatient services for 1–5-year-olds—a substitute effect was observed in this group. There is need for further research to examine the longterm effects of the coinsurance reduction policy.
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Objectives@#Anxiety disorder is among the most prevalent mental illnesses among adolescents. Early detection and proper treatment are important for preventing sequelae such as suicide and substance use disorder. Studies have suggested that sleep duration is associated with anxiety disorder in adolescents. In the present study, we investigated the association between sleep quality and anxiety in a nationally representative sample of Korean adolescents. @*Methods@#This cross-sectional study was conducted using data from the 2020 Korea Youth Risk Behavior Web-based Survey. The Generalized Anxiety Disorder-7 questionnaire was used to evaluate anxiety. The chi-square test was used to investigate and compare the general characteristics of the study population, and multiple logistic regression analysis was used to analyze the relationship between sleep quality and anxiety. @*Results@#In both sexes, anxiety was highly prevalent in participants with poor sleep quality (adjusted odds ratio [aOR], 1.56; 95% confidence interval [CI], 1.43 to 1.71 in boys; aOR, 1.30; 95% CI, 1.19 to 1.42 in girls). Regardless of sleep duration, participants with poor sleep quality showed a high aOR for anxiety. @*Conclusions@#This study identified a consistent relationship between sleep quality and anxiety in Korean adolescents regardless of sleep duration.
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This study aimed to update suicide-related indicators including suicidal ideation, suicide attempts, and the number of suicidal deaths.Based on up-to-date information, we observed the trends of suicide-related indicators. In this study, five data sources were used to observe the trends of suicide-related indicators: Statistics Korea (1983–2019), Korean National Health and Nutrition Examination (KNHANES, ‘07–13, ‘15–19), Korean Community Health Survey (KCHS, ‘08–09, ‘13, ‘17), Korean Wealth Panel Study (KOWEPS, ‘12–19), and Korea Health Panel Survey (KHP, ‘10–13, ‘16-17). The suicide rate, which peaked in 2011, declined until 2017 and then started to rise again from 2018, recording a suicide rate of 26.9 per 100,000 people in 2019. The rate of suicidal ideation estimated based on the recently available data was 4.62% (KNHANES, ‘19), 3.51% (KHP, ‘16), 2.87% (KHP, ‘17), and 1.70% (KOWEPS, ‘19). That of suicide attempt as recent year was 0.43% (KNHANES, ‘19), 0.07% (KOWEPS, ‘19). Annual percentage change of death by intentional self-harm was -2.11% (Statistics Korea), and that of suicidal ideation was -14.7% (KNHANES), -2.5% (KCHS), -10.6% (KOWEPS), and -11.3% (KHP). Annual percentage change of suicide attempt was -5.0% (KNHANES), -4.4% (KCHS), and -11.3% (KOWEPS). The lower the income level, the higher the probability of experiencing suicide ideation and suicide attempts. Considering the recent increase in suicide rate in contrast to the continuing decline in suicidal ideation and suicide attempts, continuous data observation and appropriate policies regarding suicide prevention are needed.
ABSTRACT
Unmet healthcare is an important indicator to measure accessibility of healthcare services. To examine the latest status of unmet healthcare needs in South Korea, the four different data which is composed of nationally representative sample of South Korean population were used; the Korea Health and Nutrition Examination Survey (KNAHANES, 2007–2019), the Community Health Survey (CHS, 2008–2019), the Korea Health Panel Survey (KHP, 2011–2017), and the Korean Welfare Panel Study (KOWEPS, 2006–2019). The proportion of individuals reporting unmet healthcare needs were 5.8% (KNHANES), 5.3% (CHS), and 11.6% (KHP). Annual percentage change (APC) which identifies trend for the follow-up period was -9.5%, -8.0%, and -6.5%, respectively. The proportion of individuals reporting unmet healthcare needs due to cost were 1.1% (KNAHANES), 0.7% (CHS), 2.4% (KHP), and 0.4% (KOWEPS). The APC was -10.5%, -14.2%, -12.2%, and -19.6%, respectively. Compared to last year, the rate of unmet healthcare needs has declined in general.However, the low-income and the elderly population were reporting the highest rate of unmet health care needs, and the disparity between lowest and highest groups were remained. These results suggest that adequate benefit coverage is needed for low-income and elderly population.
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The objective of this study is to investigate the healthcare status of South Korea and other member countries of the Organization for Economic Cooperation and Development (OECD) using OECD health statistics 2020. We employed the position value for relative comparison index to measure the healthcare status in five following components: demand, supply, accessibility, quality, and cost. The Mann-Kendall test was used to analyze for increasing or decreasing trend of the position value for relative comparison values from 2000 to the recent year. Results showed that Korea was positioned above than the OECD median values in most of components, but lower than the median values in certain indices including healthcare employment, primary care, and mental health care. This study sheds some light on healthcare issues to be improved and the policy-makes can take into account for prior setting process.
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Background@#This study aims to measure regional healthcare differences in Korea, and define relatively underserved areas. @*Methods@#We employed position value for relative comparison index (PARC) to measure the healthcare status of 250 areas using 137 indicators in five following domains: healthcare demand, supply, accessibility, service utilization, and outcome. We performed a sensitivity analysis using t-SNE (t-distributed stochastic neighboring embedding). @*Results@#Based on PARC values, 83 areas were defined as relatively underserved areas, 49 of which were categorized as moderate and 34 as severe. The provincial regions with the most underserved areas were Gyeongbuk (16 areas), Gangwon (13), Jeonnam (13), and Gyeongnam (12). @*Conclusion@#This study suggests a relative comparison approach to define relatively underserved areas in healthcare. Further studies incorporating various perspectives and methods are required for policy implications.
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Background@#Many studies have reported noticeable increases in the proportion of employees working either relatively short or relatively long hours. Such trends have been accompanied by an increasing concern regarding work hour mismatches defined as a discrepancy between actual and preferred work hours. The aim of this study was to investigate association between work hour mismatch and depression. @*Methods@#Data regarding work hour mismatches for 47,551 adults were extracted from the 2017 Korean Working Conditions Survey. The World Health Organization-Five Well-Being Index was used to measure depression. Multiple logistic regression analyses were performed to examine the association between work hour mismatch and depression. @*Results@#Men and women workers with work hour mismatch were more likely to have depression [underemployed males: odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.14–1.49, overemployed males: OR = 1.28, 95% CI = 1.18–1.40; underemployed females: OR = 1.37, 95% CI = 1.20–1.56, overemployed females: OR = 1.12, 95% CI = 1.02–1.23]. Underemployed workers, workers who worked more than 52 hours per week, and workers with a high income level, all had higher ORs for depression. The greater the discrepancy between actual and preferred work hours, the higher OR for depression among both underemployed and overemployed workers. @*Conclusions@#A difference between actual and preferred work hours was associated with depression. Underemployed workers had a higher risk of depression than that of overemployed workers. As a work hour mismatch negatively affected workers' mental health, it is important to reduce work hours mismatches as well as shorten the absolute number of work hours.
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Objectives@#The aim of this study was to identify the association between cohabitation status and sleep quality in family members of people with dementia (PwDs). @*Methods@#Data of 190 365 participants aged ≥19 years from the 2018 Korea Community Health Survey were analyzed. Participants were categorized according to their cohabitation status with PwDs. Multiple logistic regression and ordinal logistic regression analyses were performed to evaluate the relationship between the cohabitation status of PwDs’ relatives and sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and PSQI subscales. @*Results@#Compared to participants without PwDs in their families, both cohabitation and non-cohabitation with PwDs were associated with poor sleep quality (cohabitation, male: odds ratio [OR],1.28; 95% confidence interval [CI], 1.08 to 1.52; female: OR, 1.40; 95% CI, 1.20 to 1.64; non-cohabitation, male: OR, 1.14; 95% CI, 1.05 to 1.24; female: OR, 1.23; 95% CI, 1.14 to 1.33). In a subgroup analysis, non-cohabiting family members showed the highest odds of experiencing poor sleep quality when the PwD lived alone (male: OR, 1.48; 95% CI, 1.14 to 1.91; female: OR, 1.58; 95% CI, 1.24 to 2.01). Cohabiting male and female participants had higher odds of poor subjective sleep quality and use of sleeping medications than non-cohabiting male and female participants, respectively. @*Conclusions@#The residence of PwDs and cohabitation status may contribute to poor sleep quality among PwDs’ family members. The circumstances faced by cohabiting and non-cohabiting family members should be considered when evaluating sleep quality in family members of PwDs, and appropriate interventions may be needed to improve sleep quality in both cohabiting and non-cohabiting family members.
ABSTRACT
Catastrophic health expenditure refers to measure the level of the economic burden of households due to medical expenses. The purpose of this study was to examine the proportion of households that experienced catastrophic health expenditure between 2006 and 2019 using available data from the National Survey of Tax and Benefit (NaSTaB), Korea Health Panel (KHP), and Households Income and Expenditure Survey (HIES). Trend test was used to analyze the proportion of households with catastrophic healthcare expenditure. The households experienced a catastrophic health expenditure of 2.44% in 2019 using the NaSTaB data. Trend analysis was significant with the decreasing trend (annual percentage change [APC], -4.49; p<0.0001) in the proportion of households with catastrophic health expenditure. Also, the results of the 2017 KHP and the 2016 HIES showed 2.20% and 2.92%. The trend was significantly increased in the KHP (APC, 1.79; p<0.0001) and the HIES (APC, 1.43; p<0.0001). Therefore, this study suggests that further public healthcare interventions to alleviate the burden of catastrophic health expenditure, especially for low-income households, are needed.
ABSTRACT
Background@#Many studies have reported noticeable increases in the proportion of employees working either relatively short or relatively long hours. Such trends have been accompanied by an increasing concern regarding work hour mismatches defined as a discrepancy between actual and preferred work hours. The aim of this study was to investigate association between work hour mismatch and depression. @*Methods@#Data regarding work hour mismatches for 47,551 adults were extracted from the 2017 Korean Working Conditions Survey. The World Health Organization-Five Well-Being Index was used to measure depression. Multiple logistic regression analyses were performed to examine the association between work hour mismatch and depression. @*Results@#Men and women workers with work hour mismatch were more likely to have depression [underemployed males: odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.14–1.49, overemployed males: OR = 1.28, 95% CI = 1.18–1.40; underemployed females: OR = 1.37, 95% CI = 1.20–1.56, overemployed females: OR = 1.12, 95% CI = 1.02–1.23]. Underemployed workers, workers who worked more than 52 hours per week, and workers with a high income level, all had higher ORs for depression. The greater the discrepancy between actual and preferred work hours, the higher OR for depression among both underemployed and overemployed workers. @*Conclusions@#A difference between actual and preferred work hours was associated with depression. Underemployed workers had a higher risk of depression than that of overemployed workers. As a work hour mismatch negatively affected workers' mental health, it is important to reduce work hours mismatches as well as shorten the absolute number of work hours.
ABSTRACT
Objectives@#The aim of this study was to identify the association between cohabitation status and sleep quality in family members of people with dementia (PwDs). @*Methods@#Data of 190 365 participants aged ≥19 years from the 2018 Korea Community Health Survey were analyzed. Participants were categorized according to their cohabitation status with PwDs. Multiple logistic regression and ordinal logistic regression analyses were performed to evaluate the relationship between the cohabitation status of PwDs’ relatives and sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and PSQI subscales. @*Results@#Compared to participants without PwDs in their families, both cohabitation and non-cohabitation with PwDs were associated with poor sleep quality (cohabitation, male: odds ratio [OR],1.28; 95% confidence interval [CI], 1.08 to 1.52; female: OR, 1.40; 95% CI, 1.20 to 1.64; non-cohabitation, male: OR, 1.14; 95% CI, 1.05 to 1.24; female: OR, 1.23; 95% CI, 1.14 to 1.33). In a subgroup analysis, non-cohabiting family members showed the highest odds of experiencing poor sleep quality when the PwD lived alone (male: OR, 1.48; 95% CI, 1.14 to 1.91; female: OR, 1.58; 95% CI, 1.24 to 2.01). Cohabiting male and female participants had higher odds of poor subjective sleep quality and use of sleeping medications than non-cohabiting male and female participants, respectively. @*Conclusions@#The residence of PwDs and cohabitation status may contribute to poor sleep quality among PwDs’ family members. The circumstances faced by cohabiting and non-cohabiting family members should be considered when evaluating sleep quality in family members of PwDs, and appropriate interventions may be needed to improve sleep quality in both cohabiting and non-cohabiting family members.
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Purpose@#Critical care medicine continues to evolve. However, critical care cases require increasing amount of medical resources.Intensive care unit (ICU) mortality significantly impacts the overall efficiency of healthcare resources within a system of limited medical resources. This study investigated the factors related to ICU mortality using long-term nationwide cohort data in South Korea. @*Materials and Methods@#This retrospective cohort study used data of 14905721 patients who submitted reimbursement claims to the Korean Health Insurance Service between January 1, 2011 and December 31, 2015. A total of 1498102 patients who were admitted to all ICU types, except neonatal and long-term acute care hospitals, were enrolled. @*Results@#Of the total 1498102 participants, 861397 (57.5%) were male and 636705 (42.5%) were female. The mean age at admission was 63.4±18.2 years; most of the subjects were aged over 60 years. During the 5-year period, in-hospital mortality rate was 12.9%.In Cox analysis, both in-hospital and 28-day mortality rates were significantly higher in male patients and those of lower socioeconomic status. As age increased and the number of nursing staff decreased, the mortality risk increased significantly by two or three times. The mortality risk was lower in patients admitted to an ICU of a tertiary university hospital and an ICU where intensivists worked. @*Conclusion@#The number of nursing staff and the presence of an intensivist in ICU were associated with the ICU mortality rate. Also, increasing the number of nursing staff and the presence of intensivist might reduce the mortality rate among ICU patients.
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Objectives@#Recent studies have suggested that assessing handgrip strength (HGS) asymmetry together with HGS may be helpful for evaluating problems in geriatric patients. This study aimed to identify whether HGS asymmetry, weakness, or both were associated with depression in Korean older adults. @*Methods@#This study included 4274 subjects from the sixth and seventh Korea National Health and Nutrition Examination Survey. Depression was measured using the Patient Health Questionnaire-9. The maximum HGS of the dominant hand was used as a representative value. HGS symmetry was categorized by the ratio of the HGS of the dominant hand to that of non-dominant hand. The odds ratio (OR) for depression was calculated according to the HGS and its symmetry. @*Results@#In total, 240 (12.5%) men and 534 (22.7%) women had depression. HGS or HGS asymmetry showed no statistically significant associations with depression in elderly men. Elevated odds of depression were observed in elderly women with low HGS (OR, 1.93; 95% confidence interval [CI], 1.33 to 2.81) or prominent HGS asymmetry (OR, 1.46; 95% CI, 1.02 to 2.08). There was a positive additive interaction between asymmetric HGS and weakness, as women with low and prominently asymmetric HGS showed higher odds of depression (OR, 3.77; 95% CI, 2.16 to 6.59) than women with high and symmetric HGS. @*Conclusions@#Depression in elderly Korean women was associated with both low and asymmetric HGS. Our findings support the potential value of HGS asymmetry as an indicator of HGS.
ABSTRACT
Catastrophic health expenditure refers to measure the level of the economic burden of households due to medical expenses. The purpose of this study was to examine the proportion of households that experienced catastrophic health expenditure between 2006 and 2019 using available data from the National Survey of Tax and Benefit (NaSTaB), Korea Health Panel (KHP), and Households Income and Expenditure Survey (HIES). Trend test was used to analyze the proportion of households with catastrophic healthcare expenditure. The households experienced a catastrophic health expenditure of 2.44% in 2019 using the NaSTaB data. Trend analysis was significant with the decreasing trend (annual percentage change [APC], -4.49; p<0.0001) in the proportion of households with catastrophic health expenditure. Also, the results of the 2017 KHP and the 2016 HIES showed 2.20% and 2.92%. The trend was significantly increased in the KHP (APC, 1.79; p<0.0001) and the HIES (APC, 1.43; p<0.0001). Therefore, this study suggests that further public healthcare interventions to alleviate the burden of catastrophic health expenditure, especially for low-income households, are needed.
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Korea has failed to respond to the Middle East respiratory syndrome of 2015 and the early phase of coronavirus disease 2019 (COVID-19) of 2020. This is due to the structural problems of the Ministry of Health and Welfare that has been more increased manpower and budgets of the welfare part relative to those of the health part, and the ministers were appointed welfare experts, not health experts. In 21 (56.8%) of the Organization for Economic Cooperation and Development countries, the Ministry of Health operates independently, and these countries have been relatively well coping with COVID-19. The importance of the Korean health sector is increasing even further. Korea faces on the emerging infectious diseases, chronic infectious diseases such as tuberculosis that has been being a huge burden, and rapidly increasing non-communicable diseases, suicide and mental disorders, and some diseases due to fine dust and climate change. In addition, the rapid advancement of the aging society, the entry of an era of ultra-low fertility and low-economic growth, and the unification of the Korean peninsula are calling for a health policy reform. Therefore, the Ministry of Health should be established and systematically responsible for health policy, disease policy, medical policy, and medical security policy. Ministry of Health will be the control tower for K-Disease Control, K-Bio, and K-Health.
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Coronavirus disease 2019 (COVID-19), which originated in Wuhan, China, is pandemic. It has occurred in more than 170 countries on six continents. In Korea, COVID-19’s cases are more than 9,000. The reasons of pandemic COVID-19 are that COVID-19 can spread asymptomatic or early in symptoms although similar reproductive number to severe acute respiratory syndrome coronavirus (SARS), that there are more travelers in China and world than the SARS of 2003, and that the control of COVID-19 was contaminated to political considerations in China, World Health Organization (WHO), and Korea. Emerging infectious diseases such as COVID-19 will occur in the future. To prepare for control of emerging infectious disease, first, the Ministry of Health should be independent from Ministry of Health and Welfare and the department of disease management should be established. Second, experts for making evidence about the emerging infectious diseases should be trained and the plan that is the mobilization of manpower and facilities in large cases will be established. Third, the WHO should enhance its capacity to manage emerging infectious diseases and Korea will support the country of occurred emerging diseases through experts in the analysis of emerging infectious diseases.
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Suicide has been a long-standing problem for global public health, along with almost 800,000 deaths from suicide worldwide in 2016, accounting for 1.4% of all deaths. South Korea was ranked first in suicide mortality in 2018 among countries in the Organization for Economic Cooperation and Development. This study aimed to suggest up-to-date information about suicide-related indicators such as the rate of suicidal ideation, suicide attempt, and suicide death, and its trends by applying sampling weight to make it nationally representative. In this study, we used the data sources: Korea National Health and Nutrition Examination (KNHANES, ‘07–13, ‘15–18), Korean Community Health Survey (KCHS, ‘08–09, ‘13, ‘17), Korean Wealth Panel Study (KOWEPS, ‘12–18), Korea Health Panel Survey (KHP, ‘10–13), and Statistics Korea (1983–2017). The rate of suicidal ideation as recent year was 4.73% (KNHANES, ‘17), 6.96% (KCHS, ‘17), 2.29% (KOWEPS, ‘18), and 5.39% (KHP, ‘13). That of suicide attempt as recent year was 0.51% (KNHANES, ‘18), 0.32% (KCHS, ‘17), and 0.15% (KOWEPS, ‘18). Annual percentage change (APC) of suicidal ideation was -15.4% (KNHANES, ‘07–13, ‘15, ‘17), -2.5% (KCHS, ‘08–09, ‘13, ‘17), -10.8% (KOWEPS, ‘12–18), and -10.9% (KHP, ‘10–13). APC of suicide attempt was -4.4% (KNHANES, ‘07–13, ‘15-18), -4.4% (KCHS, ‘08–09, ‘13, ‘17), and -13.6% (KOWEPS, ‘12–18). APC of death by intentional self-harm was -1.25% (Statistics Korea, ‘07–18). All suicide-related indicators were found to be decreasing in the overall from 2009. Individuals with lower income level were more likely to experience suicidal ideation and suicide attempts. Even though suicide rate had been continuously decreasing from its highest point in 2011 (suicide rate: 31.7 per 100,000 population) to 2017 (suicide rate: 24.3 per 100,000 population), it increased again in 2018 (suicide rate: 26.6 per 100,000 population). This information would be grounded on policy implementation for suicide prevention, thus continuous data observation is necessary.
ABSTRACT
Unmet healthcare needs lead to increased disease severity, increased likelihood of complications, and worse disease prognosis. To examine the latest status of unmet healthcare needs in South Korea, the four different data configured with nationally representative sample of South Korean population were used: the Korea Health and Nutrition Examination Survey (KNAHANES, 2007–2018), the Community Health Survey (CHS, 2008–2018), the Korea Health Panel Survey (KHP, 2011–2016), and the Korean Welfare Panel Study (KOWEPS, 2006–2018). The proportion of individuals reporting unmet healthcare needs were 7.8% (KNHANES, 2018), 8.8% (CHS), and 10.8% (KHP, 2016). Annual percentage change which characterizes trend for the follow-up period was -9.1%, -3.2%, and -6.8%, respectively. The proportion of individuals reporting unmet healthcare needs due to cost were 1.2% (KNAHANES, 2018), 1.2% (CHS, 2018), 2.5% (KHP, 2016), and 0.5% (KOWEPS, 2018). Annual percentage change which characterizes trend for the follow-up period was -10.3%, -12.0%, -11.3%, and -18.8, respectively. The low-income population and the elderly population were vulnerable groups reporting the highest rate of unmet health care needs. The rate of unmet healthcare needs has been declining since the past decade, still, the disparity between different income groups and age groups suggests that there are many challenges to address.
ABSTRACT
Catastrophic health expenditure refers to measure the level of the economic burden of households due to medical expenses. The purpose of this study was to examine the proportion of households that experienced catastrophic health expenditure between 2006 and 2018 using available data from the National Survey of Tax and Benefit (NaSTaB), Korea Health Panel (KHP), and Households Income and Expenditure Survey (HIES). Trend test was used to analyze the proportion of household with catastrophic healthcare expenditure. The households experienced the catastrophic health expenditure 2.08% in 2018 using the NaSTaB data. Trend analysis was significant with the decreasing trend (Annual Percentage Change [APC], -4.88; p<0.0001) in the proportion of households with the catastrophic health expenditure. On the other hand, the results of the HIES showed 2.92%, and KHP showed 2.48% of households experienced the catastrophic health expenditure in 2016. The trend was significantly increased in HIES (APC, 1.43; p<0.0001) and KHP (APC, 6.68; p<0.0001). Therefore, this suggests that further interventions to alleviate the burden of catastrophic health expenditure to the low-income group are needed.
ABSTRACT
The purpose of this study was to compare the health status of South Korea with those of Organization for Economic Cooperation and Development (OECD) countries and examine the trends. Position vAlue for Relative Comparison (PARC) was used as a gauge for comparison, and five sectors of the health care system were measured: demand, supply, accessibility, quality, and cost. The Mann-Kendall test was used as a statistical analysis method to examine trend of PARC values obtained from 2000 to recent years. According to the results, the demand, supply, accessibility, and quality sectors were higher than the OECD average, while the cost was lower than the average. However, there is a recent trend of sharp increases in health care costs. Some indicators: health employment, quality of primary care and mental health care were lower than the OECD average, and health determinants showed a worsening trend. Therefore, policy-makers need to take this into account and make efforts for sustainable health care.