Service Demand for and Awareness of a Primary Healthcare Pilot Project for People With Disabilities

Background@#This study investigated the demand for and awareness of a primary healthcare pilot project for people with disabilities; it also sought to identify relevant determinants for demand and awareness using Andersen’s behavioral model of health service use. @*Methods@#This study is a secondary analysis of data from the population-based survey conducted in Gyeonggi Regional Health & Medical Center for People with Disabilities. The data was designed with quota random sampling based on the population with disabilities in each district (city [si] and county [gun]) across the Gyeonggi province (do) to evaluate the health and healthcare accessibility of the disabled people living in the Gyeonggi province. The data was collected through the mobile-based survey of 1,140 people with disabilities living in Gyeonggi-do between March 2021 and June 2021. @*Results@#Awareness of the service (12.1%) was remarkably low, while the demand (80.5%) was high. The gap between respondents who needed the service but were unaware of it differed according to age, education, activities of daily living, health information sources, chronic disease, depression, subjective health status, and unmet healthcare needs. Chronic disease (odds ratio [OR], 1.86; P = 0.001) and an unmet need for medical care (OR, 2.30;P= 0.002) had significant influences on demand for the service. Furthermore, living alone (OR, 0.42; P = 0.023), medical aid program beneficiary status (OR, 2.10; P = 0.020), access to health information from health service centers (OR, 4.00; P = 0.002), chronic disease (OR, 1.68; P = 0.043), severity of disability (OR, 1.78; P = 0.025), and subjective health status (OR, 4.51; P < 0.001) significantly affected awareness of the program. @*Conclusion@#Chronic disease and an unmet need for medical care were key determinants of service demand, while the severity of disability was not. Thus, there is a need to review the initiative that defines service beneficiaries as people with severe disabilities. Policy makers should consider advertising programs to improve service awareness among people with disabilities.

A Preliminary Study for the Curriculum Development of Community Care Coordinators: Educational Needs Analysis

Purpose@#A care coordinator is an emerging nursing professional role in South Korea. The purpose of this study was to identify educational needs and priorities for care coordinators among nurses. @*Methods@#An online survey was conducted on 661 current or retired nurses from January 30 to February 28, 2021. A total of 17 essential competencies for care coordinators, recognized based on literature review, were used to analyze the educational needs. The data were analyzed using descriptive statistics, a paired t-test, and one-way analysis of variance with SPSS 25.0. The educational needs analysis was conducted by using a paired t-test, the Borich Needs Assessment Model, and the Locus for Focus Model. @*Results@#Five contents were identified as the first priorities for educational needs: ‘Health program planning and evaluation’, ‘Care planning’, ‘Coordinating community-based services’, ‘Case management’, and ‘Transitional care’. The second priorities for educational needs included 'Population health management' and'Welfare resource linkages via communicating with social workers’. @*Conclusion@#The priority items derived from this study offer underpinning insights for the development of care coordination training program.

Contract Employment Experiences of Visiting Nurses at Public Health Centers in the Metropolitan Area: Focused on Employment Type and Treatment

Purpose@#This study was conducted with a focus group interview that drew out experiences, limitations, and difficulties in the workplace according to the employment conditions of visiting nurses in the public health centers. @*Methods@#A total of 12 visiting nurses are those working in the public sector in Seoul and Gyeonggi province who were willing to participate in the interview. Analysis categories and coding were divided into three categories: compensation system, occupational status, and opinions to improve their treatment. Using the content analysis method, the current working status and compensation system of visiting nurses were described. @*Results@#The main themes derived from the significant statements of visiting nurses were ‘Ten years of frozen salary system’, ‘Full-time workers of their own league’, ‘Excluded from performance benefits’, ‘Every visiting nurses are virtually precarious’, ‘Experience of exclusion and discrimination’, and ‘Reasons and barriers to be a full-time worker’. All of the visiting nurses working in the community insisted on having equal treatment for work of equal value. Visiting nurses in the public health sector wanted to be set to the same payment system and the fair allowance system as well. It is necessary to continuously seek solutions to the problems left in insisting on the civil service of visiting nurses. @*Conclusion@#Visiting nurses who were working in a precarious job position felt job insecurity, and experienced discrimination, alienation, and exclusion. Legal and institutional reform is needed to improve the treatment of visiting nurses.

Willingness to Use and Appropriate Payable Cost for Visiting Nurse Service for the Elderly in the Community

Purpose@#This study aimed to measure willingness to use (WTU) and appropriate payable cost of visiting nurse service for the elderly and explore their impact factors. @*Methods@#The study included 752 participants selected from data that were completed in 2017 for the elderly aged over 60 nationwide. Logit and Tobit regression analysis were performed to confirm the influencing factors. @*Results@#The study found that 39.1% of the elderly in the community were WTU the visiting nurse service, and they reported that the cost per visit was 12,650 Korean Won. The factors influencing WTU were having less than moderate subjective health status (OR = 1.63, p = .011), being part of a social participating groups (OR = 1.50, p = .046), or participation in senior health promotion programs (SHPPs) (OR = 1.96, p = .003). The cost was also influenced by less than moderate subjective health status (β = 4.37, p = .021), being part of a social participating groups (β = 4.41, p = .028), or participation in SHPPs (β = 4.87, p = .023). Additionally, elderly people living alone who were used as covariates were highly WTU (OR = 2.20, p = .029). @*Conclusion@#This study provides evidence to predict demand for visiting nurse service and reflects consumer value in setting the service cost. This is the first study to derive cost from consumers' perspective regarding the service for the elderly. As it is the result of an open-ended survey, follow-up studies are needed to estimate more reliable and reasonable results.

Analysis of Trends in Willingness to Pay Research in Healthcare Service of Korea

Purpose@#This study was to review the previous studies on the ‘Willingness to Pay (WTP)' for healthcare services and suggest future implications for nursing research. @*Methods@#Using the scoping review method, we used RISS, KISS, KMbase, Koreamed, PubMed, EMbase, CINAHL as searching engines. According to the selection and exclusion criteria, 40 appropriate studies were selected and analyzed. @*Results@#24 studies were categorized into medical service field among medical, public health, and nursing service fields. A total of 16 studies were related to healthcare system (policies), 13 studies were to the healthcare intervention, and 11 studies were categorized into the health management. Most of the methods for eliciting WTP (70%) were about a contingent valuation method (CVM), and the use of double bounded dichotomous choice (DBDC) tended to increase. In the nursing field, five WTP studies were identified: two studies published in the early years of 2000, which were conducted on hospital-based home health visit services. Recent studies were mostly about counseling and education by advanced practice nurses (APNs). @*Conclusion@#WTP studies on healthcare services were largely published from the medical fields and health policy areas with the CVM method. In the field of nursing, studies have been conducted on the subject of limited service areas. More active exploration of research topics is required, particularly under the current policy setting, where discussion of the public health insurance fee for nursing practice is essential.

Who Are the People Willing to Pay for Physician Home Visits?

Background@#Since the recently announced Community Care Policy, there has been an opinion that Korea needs to establish an alternative medical model such as physician home visits. This study aimed to assess the need and willingness to pay (WTP) for physician home visits among the community-dwelling Korean older population and to determine the most important factors that influence older adults to decide to use a physician home visit service. @*Methods@#A total of 797 people aged 60 years or older who were randomly selected from a nationwide dataset using a multi-stage stratified sampling method answered a questionnaire on the need and WTP for physician home visits. @*Results@#A total of 39.3% of participants reported that they would like a physician home visit when they need help. Among older adults who needed physician home visits (n = 313), the WTP amount for physician home visits was 21,982 ± 17,546 KRW. Logit and Tobit regression analyses showed that the higher valuated need and WTP for physician home visits was associated with a lower level of physical/psychosocial functioning measured by EuroQol-five dimensions score (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01–1.27; P = 0.035) and a higher level of satisfaction when using community-based services such as public health centers (OR, 1.32; 95% CI, 1.02–1.72; P = 0.034), social welfare centers and Gyeong-ro-dang (OR, 1.61; 95% CI, 1.04–2.50; P = 0.033; β = 8.39; standard error, 3.63; P = 0.021). @*Conclusion@#This study provides evidence that the decision to pay for a physician home visit service is based upon the complex interactions among an individual's physical and psychosocial functioning, personal experiences of service utilization, and demographic factors. The value for physician home visits should be qualified based on the empirical data of WTP, which comes from a consumer-centered perspective.

Who Comes to the Emergency Room with an Infection from a Long-term Care Hospital? A Retrospective Study Based on a Medical Record Review

PURPOSE: Health careeassociated infections increase disease prevalence and mortality and are the main reason for the hospitalization of the elderly. However, the management of underlying infections in patients hospitalized in long-term care hospitals (LTCHs) is insufficient, and the transfer of these poorly managed patients to the emergency room (ER) of an acute care hospital can lead to rapid spread of infection. This study investigated the risk factors associated with an ER visit due to infections that developed in LTCHs. METHODS: The electronic medical records of patients who were transferred to the ER of a university hospital in South Korea were used. Infection prevalence, causative infectious agent, and antibiotic sensitivity were assessed. The associations between patient characteristics and hospital-associated infections were examined using multiple logistic regression analyses. RESULTS: Among the 483 patients transferred to the ER during the study period, the number of infection cases was 197, and 171 individuals (35.4%) had one or more infections, with pneumonia being the most common (52.8%), followed by urinary tract (21.3%) and bloodstream (17.8%) infections. Patients with bedsores, fever, an indwelling catheter, and a higher nursing need were more likely to be seen in the ER because of infectious disease from an LTCH. CONCLUSION: Both an intensive care system and surveillance support should be established to prevent infections, particularly in high-risk patients at LTCHs.

Urinary Incontinences Are Related with Fall and Fragility Fractures in Elderly Population: Nationwide Cohort Study

BACKGROUND: This prospective cohort study used nationwide claims data to investigate the incidence of fall and fragility fractures in association with urinary incontinence (UI) in the elderly, and to compare mortality after fragility fractures in elderly patients with or without incontinence. METHODS: A total of 39,854 Korean adults (age, 66–80 years) who participated in health examinations between 2007 and 2012 and were followed up until 2015 were analyzed. Patient and comparison groups were classified according to the presence or absence of UI. The cumulative incidence of osteoporotic fragility fractures and falls in the 2 groups was assessed and compared. Hazard ratios for fragility fractures were calculated for the risk of UI in association with falls using a Cox proportional hazards model. RESULTS: Of 39,854 elderly participants, 5,703 were classified in the UI group, while 34,151 were placed in the comparison group. Fall rates were significantly higher (20.8%) in the incontinence group than in the comparison group (4.7%) (P < 0.001). Women in the incontinence group (13.9%) showed a significantly higher incidence of all types of fragility fractures than those in the comparison group (11.8%) (P=0.005). After adjustment for confounders, UI was not a significant risk factor for fragility fractures in men (P=0.878) or women (P=0.324). CONCLUSIONS: This study demonstrated that elderly women with UI have a significantly higher incidence of osteoporotic fragility fractures. In addition, elderly women are at higher risk for falls.

Needs for Medical and Rehabilitation Services in Adults With Cerebral Palsy in Korea

OBJECTIVE: To investigate medical comorbidities and needs for medical and rehabilitation services of adults with cerebral palsy (CP) in Korea. METHODS: This was a prospective cross-sectional study. One hundred fifty-four adults with CP were enrolled in the study between February 2014 and December 2014. Information was obtained from participants regarding functional status, demographic and socioeconomic data, medical problems, and requirements for and utilization of medical and rehabilitation services. RESULTS: The participants included 93 males and 61 females with a mean age of 40.18±9.15 years. The medical check-up rate of adults with CP was lower than that of healthy adults and the total population with disabilities (53.2% vs. 58.6% vs. 70.4%). A quarter of the subjects failed to visit the hospital during the past year, and the main reason was the financial burden. Due to a cost burden and lack of knowledge, more than one-third of the subjects had unmet needs for rehabilitation services; the majority reported needs for rehabilitation services, such as physical therapy for pain management. CONCLUSION: The medical check-up rate was lower in the adults with CP, even though their medical comorbidities were not less than those of healthy people. Several non-medical reasons hindered them from receiving proper medical and rehabilitation services. Such barriers should be managed effectively.

The Relationship Between Job Stress, Job Satisfaction, and the Symptom Checklist-90-Revision (SCL-90-R) in Marine Officers on Board / 예방의학회지

OBJECTIVES: This study was conducted to investigate the relationships among job stress, job satisfaction, and mental health in marine officers. METHODS: The researchers gathered data on marine officers working at a harbor in Chungcheong Province, South Korea, using a self-reported questionnaire. Mental health was measured by the Symptom Checklist-90-Revision (SCL-90-R), and general characteristics including socioeconomic factors, job stress, and job satisfaction were measured by structured questionnaires. Multiple regression analysis was performed to investigate the relationships among job stress, job satisfaction, and mental health status according to the symptom dimensions of the SCL-90-R. RESULTS: Among the marine officers, obsessive-compulsive behavior, depression, and somatization were the most problematic symptoms. Those who reported poor health, low job satisfaction, and high job stress had a higher prevalence of psychoticism, somatization, depression, anxiety, and phobic anxiety. CONCLUSIONS: An occupational health system should be introduced that would regularly check the mental health of marine officers in charge of ships and sailors, in order to help reduce their stress levels, enhance their job satisfaction, and thereby improve their mental health.

Falls in Korean Polio Survivors: Incidence, Consequences, and Risk Factors

Falls and fall-related injuries are important issue among polio survivors. The purpose of this study was to determine the incidence of, and consequences and factors associated with falls among Korean polio survivors. A total of 317 polio survivors participated in this study. All participants completed a questionnaire including fall history, symptoms related to post-polio syndrome and other information through a telephone interview. Among them, 80 participants visited our clinic for additional physical measurements and tests. Of the 317 respondents, 68.5% reported at least one fall in the past year. Of the fallers, 42.5% experienced at least one fall during one month. Most falls occurred during ambulation (76.6%), outside (75.2%) and by slipping down (29.7%). Of fallers, 45% reported any injuries caused by falls, and 23.3% reported fractures specifically. Female sex, old age, low bone mineral density, the presence of symptoms related to post-polio syndrome (PPS), poor balance confidence, short physical performance battery and weak muscle strength of knee extensor were not significantly associated with falls. Only leg-length discrepancy using spine-malleolar distance (SMD) was a significant factor associated with falls among Korean polio survivors. Our findings suggest that malalignment between the paralytic and non-paralytic limb length should be addressed in polio survivors for preventing falls.

Effect change of obesity on diabetes depending on measurement: self-reported body mas index from 2012 Community Health Survey vs. directly measured from the Korea National Health and Nutrition Examination Survey / 한국역학회지

OBJECTIVES: Obesity is a well-recognized risk factor for type 2 diabetes mellitus (DM) among young and middle-aged adults in South Korea. To elaborate on the association between obesity and Diabetes mellitus (DM), subjective data from self-reporting survey or objective data from health examination is generally used. This study was conducted to validate the change of association from using these different measurements. METHODS: Community Health Survey data and Korea National Health and Nutrition Examination Survey data, as subjective and objective data respectively, were used. Population, resident in Seoul and over 45 aged, were selected for the study and the association between obesity and DM were defined by using multivariate logistic regression model. RESULTS: In subjective data, DM prevalence was 12.4% (male, 14.7; female, 10.6) and obesity prevalence was 26.0% (male, 29.2; female, 23.4). Whereas, in objective data, DM prevalence was 15.0% (male, 17.8; female, 12.9), and obese population was 32.4% (male, 34.4; female, 30.8). Based on the effect of obesity on DM prevalence from each data, using objective data increased the impact of obesity. Difference of relative risk of obesity between from subjective data and from objective was bigger in female than male and statistically significant. CONCLUSIONS: The differences of association pattern between subjective and objective data were found, due to higher obesity prevalence in objective data, and discrepancies of socio-economic status. These discrepancies could be inevitable Therefore we have to face them proactively, and understand the different aspect of various variables from different measurement.

Post-Polio Syndrome and Risk Factors in Korean Polio Survivors: A Baseline Survey by Telephone Interview

OBJECTIVE: To obtain information on the socioeconomic, medical, and functional status of polio survivors, and to use these results as the preliminary data for establishing the middle-aged cohort of polio survivors. METHODS: The subjects were recruited based on the medical records of multiple hospitals and centers. They were assessed through a structured questionnaire over the phone. Post-poliomyelitis syndrome (PPS) was identified according to the specified diagnostic criteria. Differences between polio survivors with or without PPS were evaluated, and the risk factors for PPS were analyzed by the odds ratio (OR). RESULTS: Majority of polio survivors were middle-aged and mean age was 51.2+/-8.3 years. A total of 188 out of 313 polio survivors met the adopted criteria for PPS based on the symptoms, yielding a prevalence of 61.6%. Mean interval between acute poliomyelitis and the development of PPS was 38.5+/-11.6 years. Female gender (OR 1.82; confidence interval [CI] 1.09-3.06), the age at onset of poliomyelitis (OR 1.75; CI 1.05-2.94), the use of orthoses or walking aids (OR 2.46; CI 1.44-4.20), and the history of medical treatment for paralysis, pain or gait disturbance (OR 2.62; CI 1.52-4.51) represented independent risk factors for PPS. CONCLUSION: We found that the majority of Korean polio survivors entered middle age with many medical, functional, and social problems. Female gender, early age of onset of poliomyelitis, the use of orthoses or walking aids, and the history of medical treatment for paralysis, pain or gait disturbance were identified as the significant risk factors for PPS. A comprehensive and multidisciplinary plan should be prepared to manage polio survivors considering their need for health care services and the risk factors for late effects, such as PPS.

Life Course Approach on Health Disparities in Older Adults

When taking into account for social, economic, health disparities over the life courses among older adults, we should observe how such disparities arise and how they are maintained over the generations. The first part of this paper addressed the framework and approaches for understanding lifetime influences on late life disadvantages of health. The second part presented specific examples of late life disparities and their potential sources including chronic diseases, cognitive functions and disabilities. Context was considered to be broad and included early life experiences, descendants of generations and family influences. The third part addressed the roles of specific contextual influences. The final section of this review summarized the limitation of life course approaches and implementations for intervention. For geriatric medicine, it should be expanded into the focus of medical interventions and research of earlier age, with a wider range from individual to community and society, together with various other factors.

Intensive Exercise Reduces the Fear of Additional Falls in Elderly People: Findings from the Korea Falls Prevention Study

BACKGROUND/AIMS: Falls among older people are a major public health problem and may result in fracture, medical complications that require hospitalization, and fear of additional falls. Given the prevalence and impact of the fear of falling again, reducing the incidence of falls is important to prevent additional falls. This study analyzed whether exercise programs decrease the fear of future falls in elderly patients who have fallen previously. METHODS: A randomized controlled study was performed that included 65 elderly community-dwelling subjects who had fallen in the previous year. Subjects were randomized into two groups: an exercise group (EG, n = 36) and a control group (CG, n = 29). The EG participated in three exercise sessions per week for 12 weeks. Muscle strength, balance, agility, flexibility, and muscular endurance were measured at baseline and after 12 weeks. RESULTS: After the 12-week exercise program, the subjects in the EG demonstrated remarkable improvement in their walking speed, balance (p = 0.003), back strength (p = 0.08), lower extremity strength (p = 0.004), and flexibility (p < 0.001). When asked whether they were afraid of falling, more participants in the EG than in the CG responded "not at all" or "a little." CONCLUSIONS: The 12-week exercise program described here reduced the fear of falling (p = 0.02). It also improved the balance, flexibility, and muscle strength of the participants and was associated with improved quality of life.

Health Conditions Sensitive to Retirement and Job Loss Among Korean Middle-aged and Older Adults / 예방의학회지

OBJECTIVES: This study was conducted to examine the association between health condition and leaving the labor market among middle-aged and older adults in South Korea. METHODS: Data was obtained from individuals aged 45 years and older participating in the 2006 and 2008 Korean Longitudinal Study of Ageing. We used various health measures including chronic diseases, comorbidities, traffic accident injuries, disabilit of instrumental activities of daily living, depressive symptoms, and self-rated health. The odds ratios of job loss, and retirement, versus employment were calculated using multinomial logistic regression by each health measure. RESULTS: In our cross-sectional and longitudinal analysis, health problems related to physical disabilities had the greatest effect on leaving the worksite. A shift in health condition from good to poor in a short period was a predictor of increased risk of unemployment but a persistent pattern of health problems was not associated with unemployment. Women with health problems showed a high probability of retirement, whereas among men, health problems instantly the possibility of both job loss and retirement. CONCLUSIONS: Health problems of middle aged and older workers were crucial risk factors for retirement and involuntarily job loss. Especially functional defect and recent health problems strongly and instanty affected employment status.

Social Support, Social Network, and Frailty in Korean Elderly

BACKGROUND: The concept of frailty has been extended to include social factors such as poverty and social support networks. The frailty index developed for elderly Canadians was recently examined in terms of the current broader concept of frailty. The present study explored the relationship between social support networks and frailty in Korean elderly individuals aged 65 years or older. METHODS: A total of 1,874 people aged 65 years or older were recruited by judgment sampling of the population of Seocho-gu in Seoul and surveyed in 2011. The Korean Frailty Index, developed by the Korean Geriatric Society, was used as an outcome variable. A proportional odds model was used to evaluate the relationship between social support networks and depressive symptoms. RESULTS: The prevalence of frailty and pre-frailty were 7.7% and 25.5%, respectively. A total of 9.9% of older adults lacked a social network, and 13.6% were deficient in social support. Social support networks were associated with frailty. Adjusting for sociodemographic factors (age, sex, marital status, economic status, and education), lack of a social network and support were associated with increased odds of frailty (social network: odds ratio 2.15, 95% confidence interval 1.58-2.92; social support: odds ratio 2.01, 95% confidence interval 1.54-2.63). CONCLUSION: Consistent with the concept of frailty being broadened to include social factors, frailty among elderly individuals was found to be influenced by social support networks.

The Relationship between Frailty and Health-Related Quality of Life among Korean Elderly

BACKGROUND: Verifying the effect of frailty on health-related quality of life may help us better understand the impact of frailty. The present study explored the relationship between frailty and health-related quality of life in community-dwelling Korean elderly. METHODS: Older adults aged 65 years or older recruited by judgment sampling of the population of Seocho-gu in Seoul were surveyed in 2011. The Korean frailty index measure developed by the Korean Geriatric Society was used as the outcome variable. Proportional odds model was used to evaluate the relationship between health-related quality of life (HRQoL) and frailty. RESULTS: We found that, after adjusting for sociodemographic covariates, being prefrail or frail significantly increased the proportional odds for lowering health-related quality of life than being nonfrail. In addition, of the five components of health-related quality of life, the magnitude of the adverse effects of frailty on HRQoL was largest for pain/discomfort, with anxiety/depression being the second largest. CONCLUSION: Compared to persons who are not frail, older Korean individuals identified as frail and prefrail exhibit significantly lower HRQoL scores. This association between Korean frailty measures and the generic measure of the HRQoL may offer new information to better understand frailty within its broader context.

Informal Caregiving Patterns in Korea and European Countries: A Cross-National Comparison

PURPOSE: This ecological study examined demographic and institutional differences in informal caregiving. We conducted a cross-national study about the characteristics of informal caregivers in 12 European countries and Korea. METHODS: Data were collected from individuals aged 50 years and older participating in the 2004/2005 Survey of Health, Ageing and Retirement in Europe and the 2006 Korean Longitudinal Study of Ageing. We examined the associations between informal caregiving and macrolevel characteristics (gross domestic product, total fertility rates, labor force participation rates, level of women's empowerment, long-term care resources). RESULTS: Korea and some southern European countries, notably Spain and Italy, had high percentages of women, homemakers, coresidents, and spouses in informal caregiving roles. In contrast, Northern European countries such as Denmark and Sweden had high proportions of employed informal caregivers. Lower female labor force participation was associated with higher proportions of women caregivers. A higher proportion of women caregivers in the population were also associated with a lower national gross domestic product per capita. CONCLUSION: Our findings suggest that several contextual and institutional variables are associated with the proportion of women participating in caregiving.

A Health Outcomes Approach to Evaluating Long-Term Care Facilities: Lessons from the United States

With the number of long-term care facilities in Korea increasing substantially, their quality and evaluation system has been an issue of concern. Policy makers need to consider critical aspects relating to health outcomes and client satisfaction when evaluating quality in long-term care. This requires a substantial amount of information gathered from a system of inspection, survey, data, and feedback. This study reviews the characteristics of Online Survey Certification and Reporting system (OSCAR) and the survey instrument used by the Centers for Medicare and Medicaid Services (CMS) in the U.S. and introduces the history of the U.S. nursing home (NH) inspection/survey system. OSCAR is administered by state agencies that contract with CMS and collect data through onsite inspections of facilities approximately once per year. The major components of OSCAR data are facility characteristics, resident characteristics, and survey deficiencies including scope and severity. We discuss the strengths and weaknesses of OSCAR, the primary source of information on the performance of all Medicare/Medicaid certified facilities, including a comparison of resident health outcome evaluation measurement between Korea's assessment tool and OSCAR. Introduction of a data collection system that includes a periodic survey process similar to OSCAR may help policy makers gain a better understanding of the NH industry in Korea and address shortcomings of the system.