Awareness, willingness, and challenges of the informal sector toward state National Health Insurance Services in Benin City, Nigeria

Background: As access to vital health services expands and universal health coverage is attained, health insurance is projected to serve as a critical risk protection for families and small enterprises. Aim: To assess the informal sector’s awareness, willingness, and problems in enrolling in the state national health insurance program. Materials and Methods: This cross-sectional descriptive study was done in Benin City, Nigeria, in the unorganized sector. A self-structured questionnaire was created, distributed, and retrieved for this study, which was conducted among 155 artisans chosen through a stratified random sample procedure. To evaluate the data, Statistical Package for the Social Sciences, SPSS version 22 was used. Results: In total, 138 people (89.0%) are aware of the National Health Insurance Scheme (NHIS), while only 93 people (60.0%) know that Edo state has a state-owned Health Insurance Scheme (SHIS). Only 17 people, or 11.0%, are engaged in the NHIS/SHIS program, whereas 107 people, or 77.5%, have expressed interest. Lack of accessibility to authorized healthcare facilities near house 22 (71.0%) is a significant deterrent to enrollment in the program. Long lines at service points (3.88, 1.093), the time it takes to enroll new members in the program (3.78, 1.101), the time it takes for health maintenance organizations to issue authorization codes (3.62, 1.316), the accessibility of NHIS services outside of registration institutions (3.29, 1.289), and the standard of drugs provided by the SHIS (3.12, 1.358) are all factors that hinder utilization. Sex and place of residence each strongly correlated with readiness to sign up for the program (AOR = 4.234, P = 0.017, 95% CI: 1.293–13.873 and AOR = 5.224, P = 0.007, 95% CI: 1.557–17.530, respectively). Conclusion: The artisans have a low rate of health insurance coverage but are eager to sign up for the program. State policymakers should increase their reach and make enrollment required to attain a higher range.

A summary on surveillance system of occupational disease under the framework of National Health Insurance Informatization Project / 中华劳动卫生职业病杂志

The surveillance of occupational disease has entered a new stage ofdevelopment, with the implementation of the national health informatization project. To improve the efficiency and quality of occupational disease monitoring information reporting in this paper, the system architecture and related management regulations, as long as the major changes and achievement of "surveillance system of occupational disease and health hazards information" under the framework of National Health Insurance Informatization Project were elaborated. The deficiencies existing in the system were analyzed, and expectation for the construction of the occupational disease surveillance system was addressed.

Awareness and perception of public/civil servants toward the National Health Insurance Scheme in Minna, Niger State, Nigeria

Background: Nigeria’s healthcare system has been characterized by a decline in healthcare service providers due to the inability of governments to adequately fund healthcare services over the years. Thus, this study aims to assess the knowledge and perception among public/civil servants toward the National Health Insurance Scheme (NHIS) in Minna, Niger State, Nigeria. Materials and Methods: The study was conducted using mixed qualitative and quantitative research methods. The study employed a descriptive research design that is also comparative. Data were collected using questionnaires and presented and analyzed using IBM-SPSS version 25.0 for Windows with the help of tables and graphs. Results: Most respondents were aware of the National Health Insurance Scheme (NHIS), but there was an overall unimpressive perception of NHIS funding, cost, and coverage. Age, gender, marital status, education, and grade level were not considerably associated with knowledge of NHIS (P > 0.05), but those spending more than 5000.00 Nigerian Naira (NGN) monthly on medical bills were more aware of NHIS than those paying ?2000 (P < 0.05). The perception of NHIS was not significantly associated with gender, marital status, grade level, education attainment, and monthly expenses on healthcare services (P > 0.05) but was significantly associated with age. Conclusion: The study concluded that there is a high awareness of NHIS among the study respondents, although not all had in-depth knowledge of the operations of the health insurance scheme. More efforts are required to increase awareness of NHIS and its benefits among public/civil servants in Minna, Niger State, Nigeria, to improve participation in the scheme.

Timelines of Philhealth Z Benefit Package for Standard Risk Coronary Artery Bypass Graft (CABG) Surgery at the University of the Philippines- Philippine General Hospital

@#Objective. The study evaluates the clinical profile of patients who underwent coronary artery bypass graft surgery (CABG) under the Philippine Health Insurance Corporation (Philhealth) Z Benefit Package (PZBP), as well as time intervals between PZBP screening, approval, and timing of surgery. Methods. A review of medical records was done to collect data on time intervals between the screening process and Philhealth approval in CABG patients under PZBP. The clinical profile and surgical outcomes of patients were also evaluated. Results. Sixty-three patients were included from March 2017 to December 2018. Most patients were under 61-70 years old. Hypertension was the most commonly observed comorbidity. Time intervals were analyzed including identification for surgery to eligibility screening (2–217 days, median 25 days), Philhealth approval (8–266 days, median 20 days), and surgery (9-403 days, median 33 days). Postoperative atrial fibrillation was seen in 22.58%. The most commonly observed complication prolonging hospitalization was pneumonia. Conclusion. This is the first local study which evaluated the timelines of PZBP. Results may be use as basis of follow up study in the future for identification of an acceptable timeline intervals. Several modifiable factors affecting time intervals were identified for further improvement of healthcare services. The leading cause of increase length in hospitalization were HAP and AF.

Generalized anxiety disorder in type 2 diabetes mellitus: prevalence and clinical characteristics

Objective: This study investigated the prevalence of generalized anxiety disorder (GAD) in Taiwanese patients with type 2 diabetes mellitus (T2DM). Methods: This retrospective observational study was conducted with a random sample of patients from the entire population of National Health Insurance enrollees during 2000-2010 and used ICD-9-CM diagnostic codes to identify T2DM patients and GAD. The prevalence of GAD was compared between T2DM patients and the general population. Results: Between 2000 and 2010, the prevalence of GAD was significantly greater in the T2DM patients than the general population, while the increase of GAD was higher in the general population (from 0.25 to 0.63%) than among T2DM patients (from 0.81 to 1.03%). In T2DM patients, GAD was associated with female gender, a Charlson Comorbidity Index ≥ 1, diabetes mellitus duration > 9 years, and the following comorbidities: congestive heart failure, peripheral vascular disease, and depressive disorder. The prevalence of GAD among T2DM patients was negatively associated with rapid-acting insulin injection therapy and with the use of metformin and sulfonylureas. Conclusion: Since the prevalence of GAD was greater among T2DM patients than the general population, public health initiatives are needed to prevent and treat GAD in T2DM patients, specifically those with the above mentioned risk factors.

Validity of Diagnostic Codes for Identification of Psoriasis Patients in Korea

BACKGROUND: Recently, the number of nationwide medical researches on psoriasis using the National Health Insurance Service database has been on the rise. However, identification of psoriasis using diagnostic codes alone can lead to misclassification. Accuracy of the diagnostic codes and their concordance with medical records should be validated first to identify psoriasis patients correctly.OBJECTIVE: To validate the diagnostic codes of psoriasis (International Classification of Diseases, 10th Revision L40) and to find the algorithm for the identification of psoriasis.METHODS: We collected medical records of patients who received their first diagnostic codes of psoriasis during 5 years from five hospitals. Fifteen percent of psoriasis patients were randomly selected from each hospital. We performed a validation by reviewing medical records and compared 5 algorithms to identify the best algorithm.RESULTS: Total of 538 cases were reviewed and classified as psoriasis (n=368), not psoriasis (n=159), and questionable (n=11). The most accurate algorithm was including patients with ≥1 visits with psoriasis as primary diagnostic codes and prescription of vitamin D derivatives. Its positive predictive value was 96.5% (95% confidence interval [CI], 93.9%~98.1%), which was significantly higher than those of the algorithm, including patients with ≥1 visits with psoriasis as primary diagnostic codes or including ≥1 visits with diagnostic codes of psoriasis (primary or additional) (91.0% and 69.8%). Sensitivity was 90.8% (95% CI, 87.2%~93.4%) and specificity was 92.5% (95% CI, 86.9%~95.9%).CONCLUSION: Our study demonstrates a validated algorithm to identify psoriasis, which will be useful for the nationwide population-based study of psoriasis in Korea.

Estimation of the Number of HIV Infections and Time to Diagnosis in the Korea

BACKGROUND: Statistical data of undiagnosed people living with human immunodeficiency virus (PLHIV) are of great importance to human immunodeficiency virus (HIV) infection control. This study estimated the total number of PLHIV using nationwide claims data.METHODS: This study used data of the incident HIV cases identified by the National Health Insurance System between 2009 and 2015. The number of patients with acquired immune deficiency syndrome (AIDS) was identified by diagnoses or prescription records. The estimated number of PLHIV and the time to diagnosis were calculated from the incident numbers of HIV and AIDS cases using the HIV Modeling Tool of the European Center for Disease Prevention and Control.RESULTS: Between 2009 and 2015, a total of 7,033 PLHIV and 2,899 AIDS patients were diagnosed. In 2009, the number of incident HIV cases was 873 (460 AIDS patients), increasing to 995 (337 AIDS patients) in 2015. Besides, the estimated number of prevalent cases was 10,753 in 2009, compared to 14,880 in 2015. Patients visiting health facilities accounted for 42.9% (4,616/10,753) in 2009 and 64.1% (9,544/14,880) in 2015. In 2009, there were 8,363 (77.8%) undiagnosed HIV cases, experiencing a decline to 6,215 (41.8%) in 2015. It took a mean of 6.96 years to diagnose after HIV infection.CONCLUSION: This study estimates the total burden of HIV infection in Korea for the first time using an internationally recognized HIV modeling tool. Claims data can be used to estimate the number of undiagnosed cases by identifying the total number of PLHIV and AIDS patients visiting health facilities.

Towards universal quality health care through an independent accreditation agency: A review

Background@#Guaranteeing quality of health care services is part of the objectives of Republic Act No. 11223 or the Universal Health Care (UHC) Act of 2019. In assuring that quality services are delivered by health care providers, they must be accredited to participate in the National Health Insurance Program. The UHC Act mandates the Philippine Health Insurance Corporation (PhilHealth) to recognize third party mechanisms as basis of granting incentives for health facilities that deliver services of higher quality. This review aimed to identify lessons and experiences from literature that can be adopted and contextualized in the Philippine setting, for strategic policies on strengthening the national health facility accreditation system. @*Methods@#A systematic review of literature was conducted to generate evidence-based recommendations from discussions on cross country experiences and local government initiatives towards improved accreditation system. @*Results@#By virtue of the UHC Act, a form of strategic purchasing is further institutionalized through a rating system that incentivizes health facilities that provide better services in terms of quality, efficiency, and equity. It is imperative to consider the country’s previous and current gaps and challenges in accreditation and adopt the best practices of other countries, as appropriate to Philippine's local settings. A tool is proposed in creating a national hospital accreditation system using the domains of leadership and governance, financing and sustainability, standards development, program management, and continuing quality improvement. @*Conclusion and Recommendations@#With the legitimacy of third party accreditation body mandated by the UHC Act, operationalization of the prescribed mechanisms and organizational structure must enjoin all pertinent stakeholders and be supported by sustainable funds and technical assistance by the government.

Moving towards evidence-informed policy development on third party accreditation of healthcare facilities in Light of the Universal Health Care Act: Policy analysis

Background@#The Universal Health Care (UHC) Act seeks to delineate the roles of key agencies and stakeholders towards equity in access to quality and affordable health care. Under the pillar of health regulation, the Philippine Health Insurance Corporation is mandated to recognize third party accreditation mechanisms as a basis for granting incentives to health facilities that provide better service quality, efficiency, and equity. @*Methods@#A systematic review of literature was conducted to generate a policy brief that outlined the strengths and weaknesses of the current accreditation system, and how to address arising fragmentation issues in implementation based on international and local evidence. To generate recommendations from a multi-stakeholder approach, a roundtable discussion enjoined by all major stakeholders of the policy issue was conducted by the University of the Philippines Manila Health Policy Development Hub in collaboration with the Department of Health. Thematic analysis of the RTD and the literature review were utilized in crafting the position statement with the general aim of producing consensus policy recommendations, as inputs in the Implementing Rules and Regulations of the Act. @*Results@#Policy analysis using results of literature review and policy discussion was crafted, with thematically arranged recommendations in the domains of leadership and governance, financing and sustainability, standards development, program development, and continuing quality improvement that could help the national health system in determining third party accreditation mechanisms set forth by the UHC Act. Significant issues raised was the composition and requirements of the third party accreditor and the risks in transition. @*Conclusion and Recommendation@#With the PhilHealth Benchbook setting the standards and with the expressed commitment of stakeholders for third party accreditation, it is an opportune time for the UHC Act to institutionalize the accreditation mechanisms that will address existing challenges of PhilHealth accreditation. The literature review and discussion bring forth the proposed tool for the criteria in selecting third party accreditors.

Reduction in inequalities in health insurance coverage and healthcare utilization among older adults in the Philippines after mandatory national health insurance coverage: trend analysis for 2003-2017

BACKGROUND@#Health policies in the Philippines have evolved in response to increasing health demands of older adults. However, there is a lack of research on equity among the ageing population in low-middle income countries. The objective of this study was to identify the trends in National Health Insurance Program (NHIP) coverage and healthcare utilization among older adults in the Philippines for the period from 2003 to 2017, during which NHIP expansion policies were implemented, focusing on reductions in socio-economic inequalities.@*METHODS@#A literature search of policies for older adults and an analysis of four Philippine National Demographic and Health Surveys (2003, 2008, 2013, and 2017) with data from 25,217 older adults who were 60 years or older were performed. The major outcome variables were NHIP coverage, self-reported illness, outpatient healthcare utilization, and inpatient healthcare utilization. Inequalities in NHIP coverage and healthcare utilization according to wealth were evaluated by calculating the concentration index for individual years, followed by a regression-based decomposition analysis.@*RESULTS@#NHIP coverage among older adults increased from 9.4 (2003) to 87.6% (2017). Although inequalities according to wealth quintile were observed in all four surveys (all P < 0.001), the concentration index declined from 0.3000 (2003) to 0.0247 (2017), showing reduced inequalities in NHIP coverage over time as observed for self-reported illness and healthcare utilization. NHIP coverage expansion for older adults in 2014 enabled equal opportunity for access to healthcare.@*CONCLUSION@#The passage of mandatory NHIP coverage for older Filipino adults in 2014 was followed by a reduction in inequality in NHIP coverage and healthcare utilization according to wealth.

Effect of Pneumonia on All-cause Mortality after Elderly Hip Fracture: a Korean Nationwide Cohort Study

60 years of age. A total of 588,147 participants were randomly selected for senior cohort using 10% simple random sampling. We identified senile (> 65 years old) patients who underwent hip fracture surgery from January 2005 to December 2014 and those who developed pneumonia during hospitalization from the NHIS-Senior cohort. The index date of hip fracture occurrence was defined as the date of admission to the acute care hospital. The last date of follow-up was defined as the date of death or 31 December 2015, whichever came first. A multivariable-adjusted Cox proportional hazards model was used to investigate the effects of pneumonia on all-cause mortality.RESULTS: During the enrollment period, a total of 14,736 patients, who were older than 65 years, underwent hip fracture surgeries. Among them, 1,629 patients (11.05%) developed pneumonia during the hospitalization. The pneumonia incidence was 16.39% (601/3,666) in men patients and 9.29% (1,028/10,042) in women patients. Compared to 13,107 non-pneumonia patients, adjusted relative risk (aRR) of death in pneumonia patients was 2.69 (95% confidence interval [CI], 2.14–3.38; P < 0.001) within postoperative 30-day, 3.40 (95% CI, 3.01–3.83; P < 0.001) within postoperative 90-day, 2.86 (95% CI, 2.61–3.15; P < 0.001) within postoperative 180-day and 2.31 (95% CI, 2.14–2.50; P < 0.001) within postoperative 1-year. According to patient's age, the aRR of death in pneumonia patients was 5.75 (95% CI, 2.89–11.43) in adults aged < 70 years, 5.14 (95% CI, 4.08–6.46) in those aged 70–79 years, 3.29 (95% CI, 2.81–3.86) in those aged 80–89 years and 2.02 (95% CI, 1.52–2.69) in those aged ≥ 90 years. The aRR was 3.63 (95% CI, 3.01–4.38) in men pneumonia patients, and 3.27 (95% CI, 2.80–3.83) in women pneumonia patients.CONCLUSION: The prevalence of pneumonia in elderly hip fracture patients was 11.05%. Men had higher incidence (16.39%) than women (9.29%). Compared to non-pneumonia patients, the pneumonia patients had higher 30-day to 1-year mortalities with aRR of 2.31 to 3.40. They had increased mortality in all age groups older than 65 years with aRR of 1.52 to 4.08. Both genders of pneumonia patients had higher risk of mortality (aRR, 3.63 in men and 3.27 in women) compared to non-pneumonia patients.

National health insurance system for universal health coverage: prospects and challenges in Saudi Arabia

Universal health coverage (UHC) is one of the major health policy objectives to achieve a Nation’s sustainable development. This goal is achieved when all citizens in the country enjoy the highest standards of healthcare at no or low cost. Many countries around the world have achieved UHC through a national health insurance framework and have an extensive range of risks funded by government revenue and contributions from both employers and employees. This study examines the feasibility of developing a National Health Insurance System (NHIS) as a way to achieve UHC in Saudi Arabia. It also highlights the potential role of health insurance in health coverage, improving the quality of care, and use of healthcare. Although establishing a NHIS poses many challenges, addressing them makes it feasible to provide and finance healthcare in the country.

Reality of Kawasaki disease epidemiology / 소아과

Epidemiologic studies of Kawasaki disease (KD) have shown a new pattern or change of its occurrence suggestive of its pathophysiology or risk factors from the first patient with KD reported in 1961. The incidence of KD in Northeast Asian countries including Japan, South Korea, China, and Taiwan is 10–30 times higher than that in the United States and Europe. Knowing the true epidemiology of KD in each country and the availability of publications of KD epidemiology also could benefit general health care providers and general population. This would enable the early detection and treatment of KD, ultimately reducing the incidence of coronary artery complications and mortality. Therefore, efforts to investigate the true epidemiology of KD should be continued in every country using a questionnaire survey, National Health Insurance system data, or combined methods depending on each country’s medical environment to ensure high-quality care of patients with KD.

Establishment of Healthcare Delivery System through Improvement of Health Insurance System / 보건행정학회지

Establishing a healthcare delivery system is key to building a cost-effective healthcare system that can prevent the waste of healthcare resources and increase efficiency. Recently, the rapid increase in the national medical expenditures due to the aging of the population and the increase in chronic diseases has raised the question about the sustainability of the healthcare system including the health insurance system. This is why we need to reform the medical delivery system, including the function setting of medical institutions. Accordingly, gradual and practical efforts based on the recognition of reality are needed for solving the problems and improving the medical delivery system. The first effort is to secure policy measures to establish functions and roles of medical institutions which are the basis of the healthcare delivery system, and a systematic medical use system for appropriate medical use. This approach can be achieved through a reasonable health insurance schemes. Without reasonable reform efforts, it will be difficult for Korea's health care system to develop into a system that can provide cost-effective and high-quality medical services that the people want.

The First Comprehensive Plan of National Health Insurance / 보건행정학회지

On May 1, 2019, the Minister of Health and Welfare announced publicly the first Comprehensive Plan of National Health Insurance (NHI). The Comprehensive Plan which is the 5-year plan including expenditure and revenue aspect of NHI, is desirable in 42 years of introduction of NHI and 30 years of universal coverage of NHI, though the Plan was late and had some conflict process. The Comprehensive Plan was established without evaluation of Moon's Care Plan, did not included to relationship with NHI and other health security systems, and did not have the blue print of NHI. The Plan was not sufficient in content of adequate health care utilization and relationship with service benefit and cash benefit. The Comprehensive Plan should be modified in considering the blue print of NHI and national healthcare system with participating stakeholder in turbulent environment-low fertility, rapid ageing, low economic growth rate, era of non-communicable diseases, unification of the Korean Peninsula, and 4th industrial revolution. Therefore, I suggest to establish the President's Committee of Improving Healthcare System for the blue print of health care and NHI.

Accessibility of Prenatal Care Can Affect Inequitable Health Outcomes of Pregnant Women Living in Obstetric Care Underserved Areas: a Nationwide Population-Based Study

BACKGROUND: As of 2011, among 250 administrative districts in Korea, 54 districts did not have obstetrics and gynecology clinics or hospitals providing prenatal care and delivery services. The Korean government designated 38 regions among 54 districts as “Obstetric Care Underserved Areas (OCUA).” However, little is known there are any differences in pregnancy, prenatal care, and outcomes of women dwelling in OCUA compared to women in other areas. The purposes of this study were to compare the pregnancy related indicators (PRIs) and adequacy of prenatal care between OCUA region and non-OCUA region. METHODS: Using National Health Insurance database in Korea from January 1, 2012 to December 31, 2014, we constructed the whole dataset of women who terminated pregnancy including delivery and abortion. We assessed incidence rate of 17 PRIs and adequacy of prenatal care. All indicators were compared between OCUA group and non-OCUA group. RESULTS: The women dwelling in OCUA regions were more likely to get abortion (4.6% in OCUA vs. 3.6% in non-OCUA) and receive inadequate prenatal care (7.2% vs. 4.4%). Regarding abortion rate, there were significant regional differences in abortion rate. The highest abortion rate was 10.3% and the lowest region was 1.2%. Among 38 OCUA regions, 29 regions' abortion rates were higher than the national average of abortion rate (3.56%) and there were 10 regions in which abortion rates were higher than 7.0%. In addition, some PRIs such as acute pyelonephritis and transfusion in obstetric hemorrhage were more worse in OCUA regions compared to non-OCUA regions. CONCLUSION: PRIs are different according to the regions where women are living. The Korean government should make an effort reducing these gaps of obstetric cares between OCUA and non-OCUA.

Determinant Of Independent National Health Insurance Ownership In Indonesia

@#The increasing of Independent National Health Insurance (NHI) membership is one of the indicators to achieve Universal Health Coverage. One of the challenges in extending such coverage is reaching it out to the informal sector. This study was aimed to analyze the determinants of Independent NHI ownership in Indonesia. This study used cross-sectional design, and the data were derived from Indonesian Family Live Survey (IFLS) 2014. 6,888 individuals aged ≥40 years were the sample of this study. To analyze the data, chi-square analysis and logistic regression were used. Based on the analysis, the proportion of respondent with Independent NHI is 16.6%. The ownership of independent NHI is influenced by the following factors: age 40-55 (PR=1.72 95%CI 1.41-2.09, p-value <0.001), Sumatra Island (PR=7.67 95%CI 5.55-10.59 p-value<0.001), very rich (PR = 2.26 95%CI 1.85-2.75 p-value <0.001), history of chronic disease (PR=1.33 95%CI 1.15-1.53 p-value<0.001), junior high school (PR = 2.21 95%CI 1.92-2.55 p-value<0.001), and urban (PR=1.79 95%CI 1.57-2.04 p-value <0.001). Region is the most dominant variable related to NHI ownership (p-value <0.001; Exp B= 7.03; 95% CI: 5.06-9.77). Independent NHI membership has not been maximal, yet. To increase this participation, the Social Security Administrator should approach each region with low NHI membership through promotion, socialization, and education about registration and the benefits of independent NHI.

Distribution of age, gender, and occupation among individuals with carpal tunnel syndrome based on the National Health Insurance data and National Employment Insurance data

BACKGROUND: The present study aimed to investigate the basic characteristics of carpal tunnel syndrome (CTS) and its differences between occupations using Korea's National Health Insurance (NHI) and National Employment Insurance (NEI). METHODS: The study participants were obtained from the NEI and NHI data from 2008 to 2015, with a diagnosis code of G560 (CTS) as the main or sub-diagnosis. Data about gender, age, diabetes mellitus, smoking, drinking, and length of employment, information about type of occupation, and number of employees according to age and occupation were obtained from NHI and NEI data. In total, 240 occupations were classified into blue-collar (BC) and white-collar (WC) work. In addition, each occupation was classified as high-risk and low-risk groups depending on the degree of wrist usage. RESULTS: The number of patients with CTS per 100,000 individuals increased with advancing age, and it was higher in women (4,572.2) than in men (1,798.5). Furthermore, the number was higher in BC workers (3,247.5) than in WC workers (1,824.1) as well as in the high-risk group than in the low-risk group in both BC workers (3,527.8 vs. 1,908.2) and WC workers (1,829.9 vs. 1,754.4). The number of patients with CTS was higher in the high-risk group than in the low-risk group among male and female BC workers and female WC workers. However, the number was higher in the low-risk group among male WC workers. In the BC category, the number of patients with CTS was highest among food processing-related workers (19,984.5). In the WC category, the number of patients with CTS was highest among social workers and counselors (7,444.1). CONCLUSIONS: The results of this study are expected to help identify occupational differences in patterns of CTS. High number of patients with CTS was seen in new jobs, as well as in previous studies.

The Effects of Short-Term and Very Short-Term Particulate Matter Exposure on Asthma-Related Hospital Visits: National Health Insurance Data

PURPOSE: The purpose of this study was to investigate the effects of short-term and very short-term exposure to particulate matter (PM) exceeding the daily average environmental standards for Korea (≤100 µg/m³ for PM₁₀ and ≤50 µg/m³ for PM(2.5)) on on asthma-related hospital visits. MATERIALS AND METHODS: This was a population-based, case-crossover study using National Health Insurance and air pollution data between January 1, 2014 and December 31, 2016. The event day was defined as a day when PM exceeded the daily average environmental standard (short-term exposure) or daily average environmental standard for 2 hours (very short-term exposure). The control day was defined as the same day of the week at 1 week prior to the event day. RESULTS: Compared with control days, asthma-related hospital visits on the 24-hr event days and 2-hr event days increased by 4.10% and 3.45% for PM₁₀ and 5.66% and 3.74% for PM(2.5), respectively. Asthma-related hospital visits increased from the 24-hr event day for PM₁₀ to 4 days after the event day, peaking on the third day after the event day (1.26, 95% confidence interval, 1.22–1.30). Hospitalizations also increased on the third day after the event. While there was a difference in magnitude, PM(2.5) exposure showed similar trends to PM₁₀ exposure. CONCLUSION: We found a significant association between short-term and very short-term PM exposure exceeding the current daily average environmental standards of Korea and asthma-related hospital visits. These results are expected to aid in establishing appropriate environmental standards and relevant policies for PM.

Pediatric Home Mechanical Ventilation in Korea: the Present Situation and Future Strategy

BACKGROUND: The number of children using home mechanical ventilation (HMV) has increased markedly in Europe and North America, but little is known about the situation in Korea. We described the clinical characteristics of children using HMV and investigated the current situation of HMV utilization in children. METHODS: Data on HMV prescriptions in year 2016 for children under the age of 19 was retrieved from the National Health Insurance Service for nationwide information. For more detailed information, data from year 2016 to 2018 was also retrieved from a tertiary center, Severance Children's Hospital. RESULTS: Nationwide, 416 children were prescribed with HMV in 2016, with an estimated prevalence of 4.4 per 100,000 children, of which 64.2% were male and mean age was 6-year-old. The estimated number of patients using invasive ventilators via tracheostomy was 202 (49%). Neuromuscular diseases were the most frequent cause (217; 52%), followed by central nervous system diseases (142; 34%), and cardiopulmonary diseases (57; 14%). In the tertiary center, a total of 62 children were prescribed with HMV (19 [31%] with non-invasive ventilation; 43 [69%] with invasive ventilation]. The number of children with HMV increased from 11 in 2016 to 29 in 2018. The mean age for initiation of HMV was 3.1 years and male patients comprised 65%. The most frequent diagnostic reason for HMV was central nervous system diseases (68%), followed by cardiopulmonary diseases (19%) and neuromuscular diseases (13%). Five patients died during the study period and five patients weaned from HMV. CONCLUSION: This study provides insights on the present situation of HMV utilization in Korean children.