Development of lifestyle disease guidelines and the role of physicians

Chronic diseases, such as hypertension and diabetes, account for 60% of global mortality. These conditions are directly related to unhealthy lifestyle habits, which are considered to be preventable risk factors, making it important to establish and maintain healthy habits. Several countries, including South Korea, have organized medical-based expert committees in order to develop and release lifestyle management guidelines. In this study, committees in the United States, United Kingdom, Netherlands, and Australia, and how they have developed guidelines, are scrutinized as benchmark policy cases. Physicians comprise most of the members of those committees, and most of the committees are operated independently from the government. All members of each committee are transparently listed on the committee's website, and the committees develop guidelines in a systematic and well-organized way. In comparison with these international committees, the relevant Korean committees (the Medical Guideline Committee and the Korean Preventive Services Task Force), have a number of things to change in terms of independence, expertise, and the process of developing guidelines. First, both of these committees are directly related to a governmental agency, the Korea Centers for Disease Control and Prevention. The proportion of physicians on the Medical Guideline Committee and the Korean Preventive Services Task Force is lower than that of other committees. Moreover, the focus of the current process of developing guidelines is limited to development itself, rather than the broader process, including re-assessment and feedback loops. This paper provides suggestions for the current lifestyle guideline committee based on case studies, with the ultimate goal of improving quality of life.

Development of lifestyle disease guidelines and the role of physicians

Chronic diseases, such as hypertension and diabetes, account for 60% of global mortality. These conditions are directly related to unhealthy lifestyle habits, which are considered to be preventable risk factors, making it important to establish and maintain healthy habits. Several countries, including South Korea, have organized medical-based expert committees in order to develop and release lifestyle management guidelines. In this study, committees in the United States, United Kingdom, Netherlands, and Australia, and how they have developed guidelines, are scrutinized as benchmark policy cases. Physicians comprise most of the members of those committees, and most of the committees are operated independently from the government. All members of each committee are transparently listed on the committee's website, and the committees develop guidelines in a systematic and well-organized way. In comparison with these international committees, the relevant Korean committees (the Medical Guideline Committee and the Korean Preventive Services Task Force), have a number of things to change in terms of independence, expertise, and the process of developing guidelines. First, both of these committees are directly related to a governmental agency, the Korea Centers for Disease Control and Prevention. The proportion of physicians on the Medical Guideline Committee and the Korean Preventive Services Task Force is lower than that of other committees. Moreover, the focus of the current process of developing guidelines is limited to development itself, rather than the broader process, including re-assessment and feedback loops. This paper provides suggestions for the current lifestyle guideline committee based on case studies, with the ultimate goal of improving quality of life.

Suggestion of Learning Objectives in Social Dental Hygiene: Oral Health Administration Area / 치위생과학회지

The purpose of this study is to propose learning objectives in social dental hygiene by analyzing and reviewing learning objectives in oral health administration area of the existing public oral health. This study is a cross-sectional study. The subjects of the study selected with convenience extraction were 15 members of the social dental hygiene subcommittee of the Korean Society of Dental Hygiene Science. Data collection was conducted by self-filling questionnaire. The research tool is from 48 items of A division in the book of learning objectives in the dental hygienist national examination, and this study classified each of them into ‘dental hygiene job relevance’, ‘dental hygiene competency relevance’, ‘timeliness’, and ‘value discrimination of educational goal setting’ to comprise 192 items. Also, to collect expert opinions, this study conducted Delphi survey on 7 academic experts. Statistical analysis was performed using the IBM SPSS Statistics ver. 23.0 program (IBM Co., Armonk, NY, USA). Recoding was performed according to the degree of relevance of each learning objective and frequency analysis was performed. This study removed 18 items from the whole learning objectives in the dental hygienist national examination in the oral health administration area of public oral health. Fifteen revisions were made and 15 existing learning objectives were maintained. Forty-five learning objectives were proposed as new social dental hygiene learning objectives. The topics of learning objectives are divided into social security and medical assistance, oral health care system, oral health administration, and oral health policy. As a result of this study, it was necessary to construct the learning objectives of social dental hygiene in response to changing situation at the time. The contents of education should be revised in order of revision of learning objectives, development of competency, development of learning materials, and national examination.

Demand and willing to pay for oral hygiene service in long-term care insurance of elderly / 대한구강보건학회지

OBJECTIVES: This study was conducted to identify the demand and willingness to pay for oral hygiene services among elderly people with long-term care insurance. METHODS: Our study was a cross-sectional analysis. Subjects comprised 126 elderly individuals from long-term home-care centers. A total of 28 centers were selected through convenience sampling from among 78 centers in ○○. For analysis, semi-structured questionnaires that required about 20–30 minutes to complete were used. Analysis was performed using SPSS 23.0 software. RESULTS: The overall demand for oral hygiene services was 44.4%, and willingness to pay was 31.0%. Thirty-three people (58.9%) of elderly those who have demand for an oral hygiene service were willing to pay for the service, and 64 people (91.4%) who did not have a demand were not willing to pay for it. Among those with partial dependence on brushing, 65.6% had demand for oral hygiene services and 50.0% were willing to pay costs. Among basic livelihood beneficiaries, 69.6% were willing to pay for oral hygiene services; general subjects and relievers were less willing to pay. CONCLUSIONS: The overall demand for oral hygiene services among elderly people was 44.4%, and the willingness to pay was as low as 31.0%.

Factors associated with diabetes outpatient use of tertiary or general hospitals as their usual source of care in Korea

Deterioration in the health care delivery system has been a growing problem in Korea. The concentration of mild patients with chronic disease in tertiary care centers or general hospitals other than in clinics results in the distortion of functional differentiation among various types of providers. This brings about not a coordination of care through well-organized a referral system but an undesirable competition between clinics and hospitals. In this study, we used a multivariate binary logistic model to estimate the factors associated with the diabetes outpatients' choice of tertiary care centers (TCCs) or general hospitals as their usual source of care. Data were collected from the 2008 Korean Health Panel. The unit of analysis was a diabetes outpatient (n=910). Our study results showed that 56% of all of the diabetes outpatients studied only used clinics for their care during the year of 2008 followed by general hospitals (16%), mixed (12%), TCCs (10%) and hospitals (6%). Among the various types of providers, TCC or general hospital users had the highest out-of-pocket payments per visit, but the lowest number of visits, tests, and prescriptions during the year of 2008. According to our regression analysis, patients with higher education, income, and Charlson Comorbidity Index levels were more likely to use TCCs or general hospitals. Compared with patients who enrolled in the National Health Insurance program, Medical Aid program enrollees were more likely to visit TCCs or general hospitals. In addition, being enrolled in private health insurance or having any disability was also positively associated with the greater use of TCCs or general hospitals. Our findings suggest that policy-makers should take into consideration the characteristics of patients in implementing policies related to the healthcare delivery system. It is also necessary to employ diverse approaches, such as regulation and incentives considering patent characteristics to reform the current defective aspects of health care utilization and provision.

Patient Satisfaction with Emergency Medical Services in Korea: What Matters Most?

PURPOSE: This study was performed to identify patient satisfaction with the emergency medical services (EMS) and its determinants. METHODS: Data were obtained from the first wave of the 2008 Korea Health Panel Survey. The unit of analysis was a case of patient visit of emergency department (ED) (n=1,280). Patient satisfaction with the EMS was categorized into two levels (1=satisfied, 2=dissatisfied). X2-test and logistic regression analysis were employed to find factors influencing the degree of EMS satisfaction. RESULTS: Among the 1,280 cases, 70.16% of patients were satisfied with the EMS. Patients who visited ED for accidents (odds ratio (OR)=1.42, p<0.05) were more satisfied with the services than those who visited ED for disease (reference). Also, patients who visited ED by private car (OR=3.05, p<0.05) or taxi (OR=4.00, p<0.05) or work (OR=4.78, p<0.01) showed higher satisfaction than those who visited ED by ambulance (reference) or 119 (OR=2.49, p<0.09). In addition, patients who experienced delay (reference) in ED admittance displayed lower satisfaction than those who did not (OR=2.06, p<0.001). Finally, patients who transferred to other hospitals (reference) after service completion indicated lower satisfaction than those who went back home (OR=4.04, p<0.0001) or were admitted (OR=5.69, p<0.0001). CONCLUSION: EMS policymakers should pay more attention not only to improve the quality level of ambulance or 119 service, but also to prevent ED delay.

How to develop social consensus for the uninsured benefit in the social insurance system

The current national health-insurance system of the Republic of Korea uses the negative-list method to determine benefit coverage, which includes most medical services. However, financial limitations have led to frequent conflicts between medical-service providers and the Health Insurance Review and Assessment Service (HIRA) about the inclusion of specific service-providers' practices within benefit coverage. The role of HIRA is to determine whether payments claimed by service providers are clinically valid and formulated in a cost-efficient manner. This article describes the present state and structure of the benefit system in the Korean national health-insurance system. We focus on issues of arbitrary uninsured benefits that may arise when service providers request patients to pay in full (with their approval) for a service that is not included in the benefits, according to the National Health Insurance Act. We also consider the legal treatment of arbitrary uninsured benefits in Korea and other countries. We suggest measures to improve the payment system for arbitrary uninsured benefits in Korea. Laws and regulations should be revised to cover these arbitrary uninsured benefits in a manner that can be agreed upon by HIRA, service providers, and patients.

Factors associated with the hypertension outpatients' choice of healthcare providers in Korea

This study was performed to identify hypertension outpatients' motivations in choosing healthcare providers i.e. tertiary hospitals, general hospitals (number of bed is more than or equal to 100), hospitals (number of bed is more than or equal to 30), and clinics for their care management and find the determinants influencing on their choice of healthcare providers. The unit of analysis was a hypertension outpatient visit (n=11,046). The chi2-test was performed to find the differences in choices of healthcare providers by patient characteristics. Additionally, ANOVA was employed to identify differences in out-of-pocket medical and medication costs by the type of provider. The 4 types of healthcare providers were then categorized into two levels (1=hospitals, 2=clinics), and finally, logistic regression analysis was performed to find factors influencing the patients' clinic visit for their care. Of the 11,046 cases, 82.9 percent of patients visited clinics for their care. The medical and medication out-of-pocket costs per case were the highest among the tertiary hospitals followed by general hospitals, hospitals, and clinics. Lower income and less education were associated with a higher frequency of clinic visits. The patients with National Health Insurance were more likely to visit clinics for their care than medicaid patients. Patients with any comorbidity or disability were more likely to visit hospitals than patients without them. Patients taking any medical test were more likely to visit hospitals than those who were not. Patients with a medication prescription were more likely to visit clinics than those without. Not only for cost-containment to maintain a sound healthcare financing system, but also to reduce the burden of hypertension patients' out-of-pocket costs, policy-makers should pay more attention to encouraging chronic patients to visit clinics rather than hospitals for their care management.