Analysis of factors affecting the unbalanced distribution of physicians’ working regions in South Korea

Background@#Many countries need help with the problem of an unbalanced distribution of physicians and hospitals. Moreover, various policies and strategies have been proposed to solve this problem. This study aimed to examine the determinants of the unbalanced distribution of physicians. @*Methods@#From the 2020 Korean Physician Survey data, 4,181 physicians practicing in Korea were limited to the subjects of the study. We analyzed the factors influencing physicians’ choice of practice location and their willingness to change their practice location from an urban to a rural area. @*Results@#The region of physicians’ hometown, medical school, and residency training hospitals determined their choice of practice location. The type of affiliated healthcare organization and the location of physicians’ hometown, medical school, and residency training hospitals affected their willingness to change their practice location from an urban to a rural area. Furthermore, the concordance rate of the regions of physicians’ hometown, medical school, and residency training hospitals with the region of their practice location was 24.9%. @*Conclusion@#In South Korea, policies for doctors have been designed without considering why they are reluctant to work in rural hospitals. To have a balanced distribution of physicians and hospitals, it is necessary to accurately analyze the status of medical resources based on regions and identify the current and future medical demand. The social situation, such as future demographic change and regional extinction, must also be fully considered. Furthermore, policies should be implemented that encourage physicians to work in rural hospitals.

Doctors’ consciousness on CCTV installation in operating rooms: A survey

Background@#A bill for the mandatory installation of closed-circuit television (CCTV) in operating rooms, still likely in breach of the constitution, was approved. When a bill infringing on individuals’ fundamental rights is drafted, alternative means of minimizing the infringement of the offender’s rights should be considered ahead of the draft. To this end, alternatives on the bill identified through the consciousness of the offender would be most realistic and much more effective. Thus, this study examined doctors’ consciousness on the mandatory installation of CCTV in operating rooms, the appropriateness of punishment for members who commit immoral and unethical behaviors, and doctors’ alternative ideas to CCTV installation in operating rooms. @*Methods@#The online survey was conducted for a week from July 9, 2021, to July 16, 2021, by the Korean Medical Association Doctors News, and 2,345 doctor members responded to the investigation. @*Results@#According to the survey, the following alternatives to CCTV installation in operating rooms were proposed: strengthening punishment for performing ghost surgery (38.3%), placing cameras at the entrance of the operating room (21.8%), mandatory written consent (pledge) (13.7%) to prevent ghost surgery for medical staff participating in the surgery, promoting self-purification (whistle-blowing) (11.5%), and a biometrics function for entering operating rooms (8.8%). @*Conclusion@#The revised medical law delegated legislative devices to subordinate statutes for minimizing infringement. Thus, new regulations should be set to reduce infringement of fundamental rights. It is hoped that doctors’ consciousness on new law could be preliminary data to regulate new rules in discussing lower statutes.

Physicians’ perception of the reform of the review and assessment system of national health insurance reimbursement claims

Background@#The Korean government has been promoting the reform of the review and assessment system of national health insurance reimbursement claims. The aim of this study was to find out physicians’ perception and evaluation of the health insurance review and assessment system and present the direction for the government’s reform plan. @*Methods@#The 2020 Korean Physician Survey questionnaire was sent to 57,714 members of the Korean Medical Association from November 19, 2020 to January 10, 2021. A total of 6,507 physicians (11.5%) responded; of these, the responses of 4,454, including the self-employed and employed, professors, and fellows, were included for analysis. The respondents’ perception of the current health insurance review system and of the government’s reform plan were analyzed. @*Results@#It was found that 84.2% of the respondents evaluated the current health insurance review system negatively—particularly in terms of medical autonomy, transparency of the review standards, the standard development and application process, and the post-review adjustment process. Furthermore, only 0.7% of the respondents evaluated the government’s reform plan positively—particularly, the utilization of clinical practice guidelines for review standards, introduction of the professional review committee, and expansion of the link between the review and assessment system. @*Conclusion@#Policymakers should understand physicians’ perception and evaluation of the health insurance review system. In addition, the reform plan should be thoroughly communicated to physicians.

Improvement of supportive systems for medically-underserved areas

In order to encourage physicians to work in medically-underserved areas, it is imperative to provide financial incentives and appropriate supportive systems. This paper reviews the concept of medically-underserved areas in Korea is welestablished with reasonable criteria and that the budget and the policy direction of the manpower support are effective.Current Concepts: Some recommendations may be needed to expand the supportive policy for medically-underserved areas. First, the selection criteria for medically-underserved areas should be revised and the evaluation index improved. Second, it is imperative to secure consistency in the legal system by containing overall contents on the definition, criteria, designation procedure, and support matters of medically-underserved areas through the revision of the Public Health and Medical Service Act. This consistency may designate and support medically-underserved areas according to the subject and type through health care resources distribution and condition at the national level. Third, an integrated regional medical service plan should be prepared through the construction of an inter-medical institution cooperation system, effort, and cooperation among parties having diverse interests. Fourth, the incentive system should be improved to secure medical personnel in medically-underserved areas. Fifth, the introduction of untact medical services and related governmental support to the area having insufficient medical personnel is needed.Discussion and Conclusion: The Korean government should seek new supportive measures and models for physicians to continue working in medically-underserved areas.

Korean physicians’ perception of professionalism and its effect on their job satisfaction / 의료커뮤니케이션

Background@#The purpose of this study was to identify of the degrees of professionalism of Korean physicians and to investigate its effect on their job satisfaction.Method: A total of 4,209 data was extracted from the 2020 Korean Physician Survey(KPS) of the Korean Medical Association(KMA). The descriptive statistics, reliability analysis, t-test, one-way ANOVA test and multiple regression analysis were conducted for data analysis. @*Results@#There were significant differences in physicians’ perception of professionalism among the subgroups of gender, age, marital status, type of employment, specialties, type of affiliated healthcare organization and ownership status of affiliated healthcare organization, and practice region. Similar results were also showed in their job satisfaction except for the subgroup of marital status. The physicians’ perception of professionalism was significantly related to the job satisfaction in terms of using the professional organization as a major referent(ß=0.112), belief in public service(ß=0.052), sense of calling to the field(ß=0.296), and autonomy(ß=0.166). @*Conclusion@#The results suggest that alternatives to enhance the professionalism of physicians should be prepared in order to improve the job satisfaction of physicians.

Financial loss of medical clinics resulted from the COVID-19 outbreak in Korea

As the world is facing an infectious disease pandemic caused by coronavirus disease 2019 (COVID-19), medical institutions are experiencing significant financial losses. we attempted to estimate such financial losses through a survey of clinics that reported temporary closure due to COVID-19 to the Korean Medical Association. As a result, the data of 56 clinics were obtained. The average closure period was 6.7 days, and the overall number of related health insurance claims and loss of sales reached 13,408,000 Korean won (KRW) and 20,911,000 KRW, respectively, while daily losses reached 1,343,000 and 2,202,000 KRW, respectively. In addition, the monthly average health insurance claims and sales were compared to those of the same month of the previous year. In January, they slightly increased by 4.4% and 7.8%, respectively, whereas in February, they slightly decreased by 10.2% and 12.4%, respectively. In March, they significantly decreased by 46.8% and 49.8%, respectively, as COVID-19 was at its peak. Considering the financial losses of clinics that played a pivotal role in quarantine at the forefront of infectious diseases, the government should prepare a reasonable compensation plan for such losses.

Financial loss of medical clinics resulted from the COVID-19 outbreak in Korea

As the world is facing an infectious disease pandemic caused by coronavirus disease 2019 (COVID-19), medical institutions are experiencing significant financial losses. we attempted to estimate such financial losses through a survey of clinics that reported temporary closure due to COVID-19 to the Korean Medical Association. As a result, the data of 56 clinics were obtained. The average closure period was 6.7 days, and the overall number of related health insurance claims and loss of sales reached 13,408,000 Korean won (KRW) and 20,911,000 KRW, respectively, while daily losses reached 1,343,000 and 2,202,000 KRW, respectively. In addition, the monthly average health insurance claims and sales were compared to those of the same month of the previous year. In January, they slightly increased by 4.4% and 7.8%, respectively, whereas in February, they slightly decreased by 10.2% and 12.4%, respectively. In March, they significantly decreased by 46.8% and 49.8%, respectively, as COVID-19 was at its peak. Considering the financial losses of clinics that played a pivotal role in quarantine at the forefront of infectious diseases, the government should prepare a reasonable compensation plan for such losses.

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.

Public perception of risk-reducing salpingectomy for preventing ovarian cancer

OBJECTIVE: The fallopian tube is considered as the site of origin of serous ovarian cancer, and risk-reducing salpingectomy (RRS) has been proposed as a new and safe strategy for preventing ovarian cancer. However, little is known about the public perception of RRS. METHODS: We performed a questionnaire survey of 100 healthy female volunteers in November 2014. Questionnaire for this survey included questions on demographics, medical history, knowledge of and belief about RRS, and barrier to its application. RESULTS: Among 100 respondents, 71% did not realize the seriousness of ovarian cancer, 79% were unaware of the fact that salpinx was the origin of ovarian cancer, and 87% stated that they had never heard of RRS as a preventive method for ovarian cancer. Also, 98% of respondents replied that they had the right to be informed about RRS and the choice given. The respondents' fears about RRS included increased risk of surgical complications (68%), no benefit (8%), and increased surgical costs (3%). CONCLUSION: Most general women were unaware of RRS as a method for preventing ovarian cancer in women at average risk. Therefore, physicians should discuss RRS with patients and consider this procedure at the time of abdominal or pelvic surgery.

Public perception of "scarless" laparoendoscopic single-site surgery in gynecology

OBJECTIVE: To investigate the public perception of laparoendoscopic single-site surgery (LESS) according to the age group. METHODS: An anonymous questionnaire about the desire for cosmesis and the preference for LESS in treatment of benign gynecologic diseases was provided to healthy volunteers (n=102). The survey participants were divided into two age groups (young women 40 years). The desire for cosmesis was assessed using a validated scale, Body Image Scale. RESULTS: All of the participants completed the questionnaire. The Body Image Scale scores were not different between the two age groups (11.5+/-3.5 vs. 11.8+/-4.0, P=0.656). The most common fear of surgery was the risk of complications in both age groups (69% in the young age group and 65% in the middle-aged group). Unless the operative risk increased, most of the participants (61% to 67%) in both age groups preferred LESS. Their choice was influenced by reduced scarring (43% to 61%), more safety (20% to 39%), reduced postoperative pain (8% to 10%), and new technology (4% to 6%). CONCLUSION: Based on these results, there was no difference in the desire for cosmesis and perception of LESS according to the age. Therefore, physicians should discuss and consider LESS even in middle-aged women.

Proposed Master Plan for Reform of the National Infectious Disease Prevention and Management System in Korea

A Middle East respiratory syndrome (MERS) - coronavirus (CoV) cluster that attacked Korea in May 2015 revealed several weaknesses in Korea's health care system in the face of the crisis of an emerging infectious disease and its public health implications. This experience has shown that is necessary to prepare comprehensive countermeasures through the cooperation of civil and public agencies to prevent a second or even third MERS outbreak and to control future crises of infectious disease and public health. The MERS Policy Committee of the Korean Medical Association has thus proposed a master plan for reform of the national infectious disease prevention and management system to prepare a new framework for national infectious disease prevention and control. The specific targets of the master plan are improvement of the system of usage of medical services and of the medical culture among national health insurance subscribers, improvement of the emergency room management system to prevent the spread of infectious disease, the establishment of a support system to promote effective voluntary infectious disease prevention activities among medical institutions, the building of a public health crisis communication system in collaboration with medical organizations, the establishment of an independent Ministry of Health and capacity building of the Korea Centers for Disease Control (KCDC), the securing of an advanced research and development system in the field of prevention and control of infectious disease, and the capacity building of professional epidemiologists and personnel needed to prevent and control infectious disease. The five core strategies of the master plan have been planned by medical experts in this order of priority: the reform of the healthcare delivery system, the independence of the Ministry of Health and capacity building of the KCDC, fundraising for a public infection management fund, enforcement of medical organization infection control, and improvement of the emergency room management system.

Estimating financial loss to medical clinics resulting from the Middle East respiratory syndrome coronavirus outbreak in Korea

Korea experienced an unprecedented national level disaster caused by the Middle East respiratory syndrome (MERS) in the first half of 2015. Because of the secretiveness of the government and the insufficiency of the nation's quarantine system, Korea could not effectively respond to the MERS coronavirus (CoV) outbreak. Many people suffered huge losses across most sectors, and medical clinics were no exception. Now the Korean Government and many professionals are discussing the matter of compensation. This study aimed to provide evidence for the necessity of compensation support. We conducted a questionnaire survey of the level of economic damage over the course of a month. The financial loss rate of medical clinics that experienced MERS damage has decreased by more than half over the previous year. The total financial loss of 48 medical clinics was about 1.6 billion Korean won (KRW) based on insurance benefits and 3.4 billion KRW based on sales. Due to the spreading of the MERS-CoV outbreak after May 20, 2015 in Korea, the loss rate in June was much higher than that in May or July. In July, the financial position tended to be restored to more than half of that in June but had not fully recovered to the level prior to the MERS-CoV outbreak. As most of the population, including professionals, perceive that the government is liable for damages from the MERS-CoV outbreak, the authorities concerned should prepare a compensation and redress plan. Furthermore, we expect our study to be used as good evidence for a redress plan for medical clinics damaged by the MERS-CoV outbreak.

Neurogenic potentials of human amniotic fluid-derived stem cells according to expression levels of stem cell markers and ingredients of induction medium

PURPOSE: We investigated the neurogenic potentials of amniotic fluid-derived stem cells (AFSCs) according to the expression levels of stem cell markers and ingredients in the neural induction media. MATERIALS AND METHODS: Four samples of AFSCs with different levels of Oct-4 and c-kit expression were differentiated neurally, using three kinds of induction media containing retinoic acid (RA) and/or a mixture of 3-isobutyl-1-methylxanthine/indomethacin/insulin (neuromix), and examined by immunofluorescence and reverse transcription-polymerase chain reaction (RT-PCR) for their expression of neurospecific markers. RESULTS: The cells in neuromix-containing media displayed small nuclei and long processes that were characteristic of neural cells. RT-PCR analysis revealed that the number of neural markers showing upregulation was greater in cells cultured in the neuromix-containing media than in those cultured in RA-only medium. Neurospecific gene expression was also higher in Oct-4 and c-kit double-positive cells than in c-kit-low or -negative cells. CONCLUSION: The stem cell marker c-kit (rather than Oct-4) and the ingredient neuromix (rather than RA) exert greater effects on neurogenesis of AFSCs.

The Gap Between Physicians and the Public in Satisfaction with the National Health Insurance System in Korea

The Korean National Health Insurance (NHI) system was an unprecedented accomplishment that was achieved in a short period of time. In this study, we sought to identify gaps between physicians and the public with respect to attitudes toward the NHI system in Korea. The study population was derived from the 2008 Korean Medical Association Survey, which was conducted to investigate satisfaction with and perceptions of the NHI system among physicians (n = 961) and the public (n = 935). Only 6.5% of the physicians were satisfied with NHI system, and 71.5% were dissatisfied with it. In contrast, 28.3% of the public were satisfied with the NHI system, and 21.4% were dissatisfied. The level of dissatisfaction expressed by physicians (2.03 +/- 0.91 on a five-point scale) was also higher than that expressed by the public (3.06 +/- 0.84). Despite rapid growth of NHI system, a large gap in satisfaction exists between physicians and the public.

Vaginal Candida and Microorganisms Related to Sexual Transmitted Diseases in Women with Symptoms of Vaginitis / 대한임상미생물학회지

BACKGROUND: The female genital tract is equipped to deal with a variety of foreign substances including a wide array of microorganisms. It is important to consider Candida-bacterial interactions in balance between healthy colonization versus vaginitis. The objectives of this study were to evaluate the association between microorganism distribution and vaginitis, and to investigate the possibility of an interaction between vaginal Candida and other microorganisms in female genital tract. METHODS: A total of 516 vaginal secretions were collected between October 2008 and June 2010 from patients with suspected vaginitis. Identification of Candida species and detection of 6 fastidious microorganisms (Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, and Ureaplasma urealyticum) were performed using a VITEK 2 system (bioMerieux, Inc., Hazelwood, MO, USA) and multiplex PCR (Seegene, Biotechnology, Inc., Seoul, Korea), respectively. RESULTS: M. genitalium, U. urealyticum, and C. trachomatis were more often detected in association with vaginal candidiasis. A statistically significant association between Candida and M. genitalium was observed (P<0.05). N. gonorrhoeae was detected less often in women with vaginal candidiasis. CONCLUSION: The results of this study suggest the possibility that vaginal Candida may associate with some microorganisms in patients with vaginitis. Further studies will be required to define the Candida-bacterial interactions and its mechanisms.

Detection of Trichomonas vaginalis, Gardnerella vaginalis, and Candida Species in Affirm VPIII, Papanicolaou Smear Test and Gram Stain / 대한임상미생물학회지

BACKGROUND: Infectious vaginitis is caused primarily by three different groups of microbial pathogens (Trichomonas vaginalis, Candida spp., and Gardnerella vaginalis). The objective of this study was to compare the Affirm VPIII assay using a DNA hybridization technique with the Papanicolaou (Pap) smear test and the Gram stain in the detection and identification of these three organisms. METHODS: A total of 300 vaginal samples were collected from women that were either symptomatic for vaginitis or asymptomatic women that were being seen for routine obstetric or gynecological care. The presence of T. vaginalis, Candida spp., and G. vaginalis was evaluated by using the Affirm VIII assay (Becton Dickinson, USA), Pap smear test, and Gram stain method, respectively. RESULTS: With the Affirm VPIII assay, 1 (0.3%) patient tested positive for T. vaginalis, 99 (33.0%) patients were positive for G. vaginalis, and 18 (6.0%) were positive for Candida spp. The detection rates of Trichomonas infection, bacterial vaginosis and candidiasis by the Pap smear test and Gram stain method were 0.7% versus 0%, 16.3% versus 35.7%, and 1.7% versus 9.7%, respectively. The differences between the detection rates of the above three organisms between the Pap smear test and the Gram stain method were statistically significant (p<0.05). CONCLUSION: The Affirm VPIII assay was more sensitive than the Pap smear test and more specific than the Gram stain method for the detection and identification of these three organisms. In addition, the results of the Affirm VPIII assay are quick to obtain and are simple and easy to interpret.

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.

Susceptibilities to Azoles of Candida albicans in Vulvovaginal Candidiasis / 대한의진균학회지

BACKGROUND: There are limited data regarding the antifungal susceptibility of Candida albicans causing recurrent vulvovaginal candidiasis. OBJECTIVE: The aim of the present study was to evaluate the effect of azoles susceptibilities on treatment failure and recurrence of vulvovaginal candidiasis. METHODS: Species identification was performed on 84 vaginal Candida isolates collected from October 2008 to June 2010 from 404 patients with suspected vulvovaginitis. MICs of C. albicans (26 isolates) to fluconazole, itraconazole, and voriconazole were tested by broth microdilution method of the Clinical and Laboratory Standards Institute (CLSI) M27-A2. RESULTS: C. albicans was the most frequently isolated (88.1%). All isolates were susceptible to fluconazole, itraconazole, and voriconazole. Trailing growth was found in treatment success group (10.0%) and treatment failure group (33.3%). CONCLUSIONS: The results of this study suggest the possibility that trailing growth have influence on treatment failure of vulvovaginal candidiasis.

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.