Association of Supplementary Private Health Insurance Type with Unmet Health Care Needs / 보건행정학회지

BACKGROUND: The extent of coverage rate of the public health insurance is still insufficient to meet healthcare needs. Private health insurance (PHI) plays a role to supplement coverage level of national health insurance in Korea. It is expected that reduce unmet need healthcare. This study was aimed to identify relationship between PHI type and the unmet healthcare need and its associated factors. METHODS: Data were obtained from the 2014 Korea Health Panel Survey using nationally representative sample was analyzed. Respondents were 8,667 who were adults over 20 years covered by PHI but have not changed their contract. According to the enrollment form, PHI was classified into three types: fixed-benefit, indemnity, and mixed-type. To identify factors associated with unmet needs, multiple logistic regression conducted using the Andersen model factors, which are predisposing factors, enabling factors, and need factors. RESULTS: Our analysis found that subjects who had PHI with mixed-type were less likely to experience unmet health care needs compared than those who did not have it (odds ratio, 0.80; 95% confidence interval, 0.66–0.98). As a result of analyzing what affected their unmet healthcare needs, the significant factors associated with unmet medical need were gender, marital status, residence in a metropolitan area, low household income, economic activity participation, self-employed insured, physically disabled, low subjective health status, and health-risk factors such as current smoking and drinking. CONCLUSION: The results of this study suggest that having PHI may reduce experience of unmet healthcare needs. Findings unmet healthcare needs factors according to various subjects may be useful in consideration of setting policies for improving accessibility to healthcare in Korea.

Relationship between Cancer Worries and Breast Cancer Screening with and without Family History among Korean Women / 보건행정학회지

BACKGROUND: Women with family history of breast cancer are more likely to be worried about having cancer and participate in breast cancer screening. However, few studies have examined relationship between family history, cancer worries, and participating in breast cancer screening in Korea. This study is to identify relationship between family history, cancer worries, and participating in breast cancer screening among women with and without family history of cancer. METHODS: Respondents were 2,364 women who based on the 2013 Korean National Cancer Screening Survey which is done by National Cancer Center in Korea. Chi-square tests were performed to determine differences of cancer worries, undergoing of breast cancer screening and methods such as mammogram and ultrasonogram with and without cancer family history. Univariate and multiple logistic regression were performed to identify if family history and cancer worries are related factors on participating in breast cancer screening and methods. Stratified analysis was performed to confirm the effect of ultrasonogram on the dense breast by age. RESULTS: Women with cancer family history frequently checked condition for conscious of having cancer (p=0.0299) and had highly perception of risk about having cancer in the future (p≤0.0001). Women aged 30–49 did not perform significantly more ultrasonogram than women aged over 50 years old. Checking condition (moderate odds ratio [OR], 1.38; 95% confidence interval [CI], 1.20–2.08; frequently OR, 1.58; 95% CI, 1.08–1.76) and perception of risk (moderate OR, 3.12; 95% CI, 1.06–7.06; high OR, 2.74; 95% CI, 1.20–8.08) were related to participate in mammogram and ultrasonogram. A positive family history was related to 1.35 higher odds of performing only breast ultrasonogram (95% CI, 1.04–1.75). CONCLUSION: This study requires national education and publicity to reduce the unnecessary cost of screening, to be possible cost effective screening and to encourage women to receive more mammogram, especially women aged over 50 years old and with socioeconomic factors related to opportunistic screening.

Factors influencing on review adjustment rate in National Health Insurance: focusing on outpatient services in clinics

The aim of this study was to investigate the adjustment amount for outpatient services of clinics and to identify the factors affecting the variation of the cost between clinics in National Health Insurance in South Korea. Adjustment rate in the process of claims data review was defined as the percentage of the adjusted amount in the total claimed amount. From a total of 23,593 clinics in South Korea, 4,160 clinics accounting for 17.6% of total were selected for the study. The National Health Insurance claim data were collected during April 2007. To identify factors affecting the variation in adjustment rate between clinics, multiple regression method was used for the analysis. Older physicians were more likely to have high adjustment rate. General practitioners, orthopedic surgeons, and family physicians were more likely to have higher adjustment rate than those of internists. Physicians who have practiced between 1 and 10 years and physicians practicing in metropolitan areas had lower than their counterparts. There was a great variation in adjustment rate among physicians and the variation was affected by physicians' clinical behaviors as well as the characteristics of the clinics. Therefore, introduction of an effective management scheme for physicians' clinical behaviors is essential. Since many review adjustment occur due to the incomplete understanding about the review criteria and rules and procedure of claiming, continuing education will be a way of preventing these unnecessary review adjustments. The fact that no review adjustments were found even from the close-review implies that the current two-tiered review system (close-review and indicator-review) is an efficient way of review. Future studies are needed to classify possible cause of review adjustment such as simple errors, errors in applying the benefit scheme, and over use of services.