Factors Contributing to Increases in Prescription Drug Expenditures Borne by National Health Insurance in South Korea

PURPOSE: Rapid growth of prescription drug expenditures is a problem in South Korea. The objective of this study was to assess the contributions of four variables (therapeutic choice, drug-mix, original use, and price changes) to increases in drug expenditures paid by the National Health Insurance (NHI) in Korea. MATERIALS AND METHODS: A retrospective cohort study was conducted between January 1, 2008 and June 30, 2012 utilizing data from the NHI Claims Database of the Health Insurance Review and Assessment Service. The number of target drug types for final analysis was 13959. To analyze the growth rates of drug expenditures, this study used Fisher ideal index and the Laspeyres and Paasche indexes. RESULTS: With the exception of 2012, therapeutic choice contributed to about 40-60% of the increase in drug expenditures every year, while drug-mix contributed to another 30-40%. CONCLUSION: The rapid growth in prescription drug expenditure was found to be largely due to drug-mix and therapeutic choice over time. Original use had little impact on drug spending.

Cost-Effectiveness of Drug-Eluting vs. Bare-Metal Stents in Patients with Coronary Artery Disease from the Korean National Health Insurance Database

PURPOSE: The aim of this study was to evaluate the cost-effectiveness of the use of drug-eluting stents (DESs), as compared with bare-metal stents (BMSs) in Korea. MATERIALS AND METHODS: A retrospective cohort study was conducted between January 2000 and December 2007. Subjects were stent-treated for the first time between 2004 and 2005, with four years of follow-up (2004-2007) (n=43674). The incremental cost-effectiveness ratio (ICER) was used to calculate the costs of DESs compared with BMSs among patients with coronary artery disease (CAD). Cost-effectiveness was assessed with effectiveness defined as a reduction in major adverse cardiac events after six months and after one, two, three, and four years. RESULTS: The total costs of a DESs were 674108 Korean won (KRW) higher than that of a BMSs at the end of the follow-up; 13635 thousand KRW per patient treated with DESs and 12960 thousand KRW per patient treated with BMSs. The ICER was 256315 per KRW/death avoided and 293090 per KRW/re-stenting avoided among the CAD patients at the end of the follow-up. CONCLUSION: The ICER for the high-risk patients was lower than that for the low-risk patients. The use of DESs is clinically more useful than the use of BMSs for CAD and myocardial infarction patients, especially for those considered to be high-risk patients in Korea.

Association between parental history of allergic diseases and atopic dermatitis in school aged children

PURPOSE: This study aimed to examine the relationship between parent's history of allergic disease and children's atopic dermatitis. METHODS: Data from the 2011 Research on the Current Status of Atopic Disease with Elementary Schools and Kindergartens in Suwon were used for analysis. Among 20,052 persons consenting to the survey, 18,943 who had answered parent's history were included in the study. RESULTS: The prevalence of father, mother, and parent's allergic disease history were 8.5%, 9.5%, and 2.3%, respective. The children with atopic dermatitis comprised 15.1% of the study population. In multivariate analysis, gender, weight at birth, the practice of breast-feeding, father's educational level, the presence of chemical products in the inside, and the presence of mold were significant risk factors for children's atopic dermatitis. The multivariate-adjusted odds ratio for the occurrence of children's atopic dermatitis was 3.19 (95% confidence interval, 2.57-3.95) when subjects with and without parent's history were compared. CONCLUSION: When fathers have a history of allergic disease, children tend to have atopic dermatitis.

Determinants of Health Care Expenditures and the Contribution of Associated Factors: 16 Cities and Provinces in Korea, 2003-2010 / 예방의학회지

OBJECTIVES: The purpose of this study was to classify determinants of cost increases into two categories, negotiable factors and non-negotiable factors, in order to identify the determinants of health care expenditure increases and to clarify the contribution of associated factors selected based on a literature review. METHODS: The data in this analysis was from the statistical yearbooks of National Health Insurance Service, the Economic Index from Statistics Korea and regional statistical yearbooks. The unit of analysis was the annual growth rate of variables of 16 cities and provinces from 2003 to 2010. First, multiple regression was used to identify the determinants of health care expenditures. We then used hierarchical multiple regression to calculate the contribution of associated factors. The changes of coefficients (R2) of predictors, which were entered into this analysis step by step based on the empirical evidence of the investigator could explain the contribution of predictors to increased medical cost. RESULTS: Health spending was mainly associated with the proportion of the elderly population, but the Medicare Economic Index (MEI) showed an inverse association. The contribution of predictors was as follows: the proportion of elderly in the population (22.4%), gross domestic product (GDP) per capita (4.5%), MEI (-12%), and other predictors (less than 1%). CONCLUSIONS: As Baby Boomers enter retirement, an increasing proportion of the population aged 65 and over and the GDP will continue to increase, thus accelerating the inflation of health care expenditures and precipitating a crisis in the health insurance system. Policy makers should consider providing comprehensive health services by an accountable care organization to achieve cost savings while ensuring high-quality care.

Cardiovascular Risk Factors for Incident Hypertension in the Prehypertensive Population / 한국역학회지

OBJECTIVES: The aim of this study was to investigate the effect of changes in cardiovascular disease (CVD) risk factors on progression from prehypertension (PreHTN) to hypertension (HTN) using an 8-yr prospective Korean Cancer Prevention Study (KCPS) by the National Health Insurance Corporation (NHIC) in Korea. METHODS: A total of 16,229 subjects, aged 30 to 54, with new onset preHTN at baseline (1994-1996) in a biennial national medical exam were selected and followed up till 2004 at 2-yr intervals. All subjects underwent a biennial health examination including biochemical measurements and behavior. The log-rank test was performed to assess the relationship between changes in CVD risk factors and progression to HTN. The Cox proportional hazard model was used to identify factors influencing progression to HTN. RESULTS: With regards the progression rate in men, ex-smokers (42.9%), abstainers (37.5%), and regular exercisers (37.6%) showed a slower progression rate than continuous smokers (49.5%) and continuous drinkers (50.9%). In women, those who participated in regular exercise (22.6%) had a lower rate of progression than continuous non-exercisers (36.1%). According to the results of the Cox proportional hazard model, improvements in smoking (hazard ratio [HR], 0.756), drinking (HR, 0.669), regular exercise (HR, 0.653), body mass index (HR, 0.715), and total cholesterol (HR, 0.788) played a protective role in progression to HTN in men, while in women, participating in regular exercise (HR, 0.534) was beneficial. CONCLUSION: Improvements in CVD-related behaviors diminished the progression rate of HTN. This study suggests that individuals with PreHTN should be targeted for specific health behavioral intervention to prevent the progression of HTN.

Does Abdominal Obesity Accelerate the Effect of Hypertriglyceridemia on Impaired Fasting Glucose?

PURPOSE: This study sought to determine whether abdominal obesity is a risk factor for impaired fasting glucose (IFG) and hypertriglyceridemia and to verify whether moderate effect of abdominal obesity on the relationship between IFG and hypertriglyceridemia in Korea. MATERIALS AND METHODS: Data from the Korean National Health and Nutrition Examination Survey was used for the analysis. The study population included 5,938 subjects aged 20 year old drawn from non-diabetic participants in a health examination survey. The subjects were classified according to the presence of abdominal obesity based on waist circumference, IFG based on their fasting blood glucose level, and hypertriglyceridemia on their fasting triglyceride. RESULTS: The multivariate-adjusted odds ratios for the occurrence of hypertriglyceridemia were 2.91 in the abdominal obesity group as compared with the nonobesity group and 1.31 in subjects with IFG compared with the normoglycemia controls. Abdominal obesity was found to be positively moderated in the interaction between waist circumference and fasting blood sugar. CONCLUSION: The moderate effect between abdominal obesity and IFG contributes to the development of hypertriglyceridemia in Korea.

The Relationship of Organizational Culture and Organizational Effectiveness at the General Hospital / 예방의학회지

OBJECTIVES: Organizational culture has been important in field of organizational behavior research for the past decade. Although there has been a growing interest in the organizational culture and organizational effectiveness, there is few research in health care field. This study was carried out to investigate the relationship of organizational culture and organizational effectiveness at general hospital. METHODS: Data was collected by self-administrated questionares. Organizational cultures were measured by using Likert scale. A general hospital in Kyunggi-Do was selected and survey was conducted to 675 workers. Data was analyzed with computer package, PC- SPSS. RESULTS: There were four types of organizational culture in this hospital : consensual culture, developmental culture, hierarchical culture, rational culture. Many workers recognized their culture as rational culture and developmental culture. This finding showed that the hospital had both human related and task related climate. There were some differences in recognition of sub-organizational culture by occupational group, but perceived organizational culture was in accordance with sub-organizational culture in general. Multiple regression analysis and multiple logistic regression analysis were conducted to find the relationship of organizational culture and organizational effectiveness. As a result, developmental culture showed a strong relationship with organizational commitment and job-satisfaction. CONCLUSIONS: These results showed that types of organizational culture were significantly related to organizational effectiveness and understanding the existing culture is essential to develope their organizational effectiveness.