The Effects of National Health Insurance Denture Coverage Policies for the Elderly on the Unmet Dental Needs of the Edentulous Elderly / 치위생과학회지

As the elderly population increases, they are increasingly affected by oral health problems. Therefore, efforts are being made to improve the oral health of older people, alleviate mental discomfort, and reduce unmet dental needs. This study was conducted to confirm the relationship between the National Health Insurance Elderly Denture Coverage and the unmet dental need for the edentulous elderly, as part of the protection policy. We analyzed the 2011 and 2013 Community Health Survey data of the edentulous elderly, aged 75 years or older, before 2012. In order to more precisely confirm the effects of the denture donation policy on unmet dental care, basic life recipients who were subject to the free elderly prosthetic project were excluded from the analysis. The final analysis included 20,400 subjects. According to our investigation of the factors that affect the unmet dental needs of the elderly, the National Health Insurance Elderly Denture Coverage did not affect unmet dental needs. The statistically significant variables that affected the unmet dental needs of the elderly were education and income levels, which are representative socioeconomic status variables. The lower the level of education, the unhealthier the dental care experience, and income levels showed a similar tendency. The elderly who have a low socioeconomic status are more likely to experience unmet dental needs because they lack the knowledge and socioeconomic ability to pay for dental care. Therefore, the policy for health protection of the entire elderly population should be continuously expanded. In addition, the socioeconomically vulnerable groups may have health problems due to the restriction of medical use, which may lead to quality of life deterioration.

Impact of the Health Insurance Coverage Policy on Oral Anticoagulant Prescription among Patients with Atrial Fibrillation in Korea from 2014 to 2016

BACKGROUND: To evaluate oral anticoagulant (OAC) utilization in patients with atrial fibrillation after the changes in the health insurance coverage policy in July 2015. METHODS: We used the Health Insurance Review and Assessment Service-National Patient Samples (HIRA-NPS) between 2014 and 2016. The HIRA-NPS, including approximately 1.4 million individuals, is a stratified random sample of 3% of the entire Korean population using 16 age groups and 2 sex groups. The HIRA-NPS comprises personal and medical information such as surgical or medical treatment provided, diagnoses, age, sex, region of medical institution, and clinician characteristics. The studied drugs included non-vitamin K antagonist OACs (NOACs) such as apixaban, dabigatran, edoxaban, and rivaroxaban, and were compared with warfarin. We analyzed drug utilization pattern under three aspects: person, time, and place. RESULTS: The number of patients with atrial fibrillation who were prescribed OACs was 3,114, 3,954, and 4,828; and the proportions of prescribed NOACs to total OACs were 5.1%, 36.2%, and 60.8% in 2014, 2015, and 2016, respectively. The growth rate of OACs prescription increased from 61.4 patients/quarter before June 2015 to 147.7 patients/quarter thereafter. These changes were predominantly in elderly individuals aged more than 70 years. The proportion of NOACs to OACs showed significant regional difference. CONCLUSION: The change of health insurance coverage policy substantially influenced OACs prescription pattern in whole Korean region. But the impact has been significantly different among regions and age groups, which provides the evidence for developing standard clinical practice guideline on OACs use.

Cost Analysis for Dentures Performed at Dental Clinics in Korea / 보건행정학회지

BACKGROUND: The purpose of this study is to analyze the cost for the denture treatment in accordance with the government's plan to expand the National Health Insurance coverage for dental prothesis from July 1, 2012. METHODS: We developed the draft of classification of the treatment activities based on the existing researches and expert's review and finalized the standard procedures through confirming by Korean Dental Association. We also made the list of input at each stage of treatments. We conducted survey of 100 dental clinics via post from April 4 to May 20 in 2011 and 37 clinics took part in the survey. The unit of cost calculation is the process from the first visit for denture treatment to setting of denture and adjustment. The manufacturing process performed by dental technician was not included in the cost analysis. RESULTS: The process for the complete denture treatment was classified with 10 stages. The partial denture treatment was classified with 8 stages. The treatment time per each denture is about 5.6 hours for complete dentures and about 6.6 hours for partial dentures. The treatment cost were from 591,108 won to 643,913 won for complete denture and from 670,219 won to 738,840 won for partial denture in 2011, depending on the location, type of the clinics and the types of physician's income. CONCLUSION: This study shows the example of cost analysis for the treatment to set the fee schedule. Measures to get representative and accurate information need to be made.

Oral health-related quality of life improvements and satisfaction in South Korea: results from the National Health Insurance Coverage Denture Project for the Elderly / 대한구강보건학회지

OBJECTIVES: In this study, we assessed the effects of the National Health Insurance Coverage Denture Project for the Elderly on the improvement of oral health-related quality of life (QOL) and satisfaction. METHODS: Individuals aged > or =75 years (n=121) participated in the project at dental clinics or public health centers in Busan City, South Korea. Baseline and post-intervention follow-up surveys (personal interview) were conducted between October 2013 and April 2014. RESULTS: Significant improvements were demonstrated in all seven Oral Health Impact Profile-14 (OHIP-14) subscales at follow-up. Functional limitation showed the most improvement (2.81 points) followed by physical functionality, physical pain, psychological discomfort, social isolation, mental function, and social function. In addition, participants with no income who were required to pay for their expenses, reported higher satisfaction. The multiple logistic regression analysis showed that the rate of improvement on the OHIP-14 ten score increased in cases where participants who had to pay for their expenses (odds ratio [OR], 2.98; 95% confidence interval [CI]: 1.16, 7.66) but decreased for patients who received partial dentures (OR, 0.34; 95% CI: 0.13, 0.89), patients who expressed previous satisfaction with denture costs (OR, 0.37; 95% CI: 0.14, 0.97), and patients who had previous denture experience (OR, 0.43; 95% CI: 0.16, 1.12). CONCLUSIONS: Despite the short period (2 years), the National Health Insurance Coverage Denture Project for the Elderly was able to demonstrate significant improvements in oral health-related QOL. Therefore, the establishment and integration of this project is recommended to maintain and improve the QOL for the rapidly aging population.

Analysis of Hospital Foodservice Management and Health Insurance Coverage of Inpatient Meals in Seoul

The objectives of this study were to explore hospital foodservice management and to investigate conditions related to health insurance coverage of inpatient meals. A questionnaire was distributed to the nutrition departments of 44 hospitals in Seoul on July 2009. The average kitchen area was 0.5 m2, and centralized distribution systems were in place. Partition walls from contamination zones, separate work tables to prevent cross-contamination, exclusive areas for preparing tube feeding, and split carts with refrigerated and convection heat settings were largely used in tertiary hospitals. Most dietitians did meal rounds (93.2%) and surveyed for patient satisfaction (86.4%). The major theme of QI (Quality Improvement) was menu management (31.8%). The health insurance fees for meals were 4,938.9 won for a general diet, 5,199.8 won for a therapeutic diet, 4,067.0 won for tube feeding, 9,950.0 won for sterilized diet, and 18,383.4 won for diets not covered by health insurance. The prices for general and therapeutic diets were significantly lower in hospitals compared to tertiary or general hospitals (P<0.001). The cost composed of 48.3% food, 44.0% labor and 7.7% overhead for general diets and 47.9%, 44.5% and 7.6% for therapeutic diets. In the case of health insurance coverage for patient meals, the number of items applied to general diets averaged 2.8 out of 4 and for therapeutic diets it averaged 1.9 out of 3. To reform the health insurance coverage system for patient meals, it is urgent that the qualified level of patient meals is presented from a national viewpoint, and monitoring should be performed consistently by developing the evaluation tools.

Mortality risks of appendicitis patients Who had different levels of health insurance coverage status.

The objective of this retrospective cohort study was to determine the association between mortality risks of appendicitis inpatients with different levels of health insurance coverage status. The subjects were the appendicitis inpatients admitted to the Ministry of Public Health (MOPH) hospitals in the year 2000. The patients’ information (65,233 patients) recorded in the Diagnosis-Related Group (DRG) database of the Thai MOPH was used for this data analyses. After controlling for length of stay, age, sex, hospital type, and marital status, The results showed that patients who were in the low income scheme plan (LIS) had higher mortality risk than those who were insured (OR = 3.38, p = 0.025). However, the mortality risk of patients in the LIS plan and those of patients in other levels of health insurance coverage status (full pay, under MOPH policy, partially pay) were not different.