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ObjectivesTo determine the impact of restrictions on mobility on reducing transmission of COVID-19. DesignDaily incidence rates lagged by 14 days were regressed on mobility changes using LOESS regression and logit regression between the day of the 100th case in each country to August 31, 2020. Setting34 OECD countries plus Singapore and Taiwan. ParticipantsGoogle mobility data were obtained from people who turned on mobile device-based global positioning system (GPS) and agreed to share their anonymized position information with Google. InterventionsWe examined the association of COVID-19 incidence rates with mobility changes, defined as changes in categories of domestic location, against a pre-pandemic baseline, using country-specific daily incidence data on newly confirmed COVID-19 cases and mobility data. ResultsIn two thirds of examined countries, reductions of up to 40% in commuting mobility (to workplaces, transit stations, retailers, and recreation) were associated with decreased COVID-19 incidence, more so early in the pandemic. However, these decreases plateaued as mobility remained low or decreased further. We found smaller or negligible associations between mobility restriction and incidence rates in the late phase in most countries. ConclusionMild to moderate degrees of mobility restriction in most countries were associated with reduced incidence rates of COVID-19 that appear to attenuate over time, while some countries exhibited no effect of such restrictions. More detailed research is needed to precisely understand the benefits and limitations of mobility restrictions as part of the public health response to the COVID-19 pandemic. WHAT IS ALREADY KNOWN ON THIS TOPICSince SARS-CoV-2 became a pandemic, restrictions on mobility such as limitations on travel and closure of offices, restaurants, and shops have been imposed in an unprecedented way in both scale and scope to prevent the spread of COVID-19 in the absence of effective treatment options or a vaccine. Although mobility restriction has also brought about tremendous costs such as negative economic growth and other collateral impacts on health such as increased morbidity and mortality from lack of access to other essential health services, little evidence exists on the effectiveness of mobility restriction for the prevention of disease transmission. A search of PUBMED and Google Scholar for publications on this topic through Sep 20, 2020 revealed that most of the evidence on the effectiveness of physical distancing comes from mathematical modeling studies using a variety of assumptions. One study investigated only the combined effect of several interventions, including physical distancing, among SARS-CoV-2 infected patients. WHAT THIS STUDY ADDSThis is the first study to investigate the association between change in mobility and incidence of COVID-19 globally using real-time measures of mobility at the population level. For this, we used Google Global Mobility data and the daily incidence of COVID-19 for 36 countries from the day of 100th case detection through August 31, 2020. Our findings from LOESS regression show that in two-thirds of countries, reductions of up to 40% in commuting mobility were associated with decreased COVID-19 incidence, more so early in the pandemic. This decrease, however, plateaued as mobility decreased further. We found that associations between mobility restriction and incidence became smaller or negligible in the late phase of the pandemic in most countries. The reduced incidence rate of COVID-19 cases with a mild to moderate degree of mobility restriction in most countries suggests some value to limited mobility restriction in early phases of epidemic mitigation. The lack of impact in some others, however, suggests further research is needed to confirm these findings and determine the distinguishing factors for when mobility restrictions are helpful in decreasing viral transmission. Governments should carefully consider the level and period of mobility restriction necessary to achieve the desired benefits and minimize harm.
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BACKGROUND: The objective of this study was to examine the effect of occurrence and reoccurrence of catastrophic health expenditure (CHE) on transition to poverty and persistence of poverty in South Korea. METHODS: The data of the year 2008-2011 from the Korea Health Panel were used. CHE was defined as the share of total health expenditure in a household out of a household's total income at various threshold levels (more than 5%, 10%, 15%, and 20%). The effect of catastrophic expenditure on transition to poverty and persistence of poverty was analyzed through multivariate logistic regression. RESULTS: The shares of households facing CHE at various threshold levels have increased gradually with 37.7%, 21%, 13.1%, and 9.5% in 2011. Households facing CHE were more likely to experience transition to poverty at thresholds level of more than 5% and 20% in 2010 set. Households facing CHE seemed to experience persistence of poverty, but it was not statistically significant. About 40% of households facing CHE in 2009 encountered another shock of CHE in 2010. Households without CHE seemed to experience more transition to poverty and persistence of poverty, but it was not statistically significant. For household with multiple CHE, those with medical aid were more likely to experience transition to poverty with statistical significance, but the statistical significance disappeared in case of persistence of poverty. CONCLUSION: The Korean health system needs to be improved to serve as a social security net for addressing transition to poverty and persistence of poverty due to facing CHE.
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Composición Familiar , Gastos en Salud , Corea (Geográfico) , Modelos Logísticos , Pobreza , República de Corea , Choque , Seguridad SocialRESUMEN
BACKGROUND: The purpose of this study is to examine the characteristics of and factors associated with long-term care (LTC) utilization under public long-term care insurance (LTCI) among end-of-life older adults in Korea. METHODS: Using a 5% sample of older people aged 65 or older and their health and LTC insurance data, two-part model analyses were conducted. We compared LTC uses and their determinants during the last year of life among decedents in the year 2010 with those of survivors. We also compared the medical uses of the same sample with their LTC uses. RESULTS: The end-of-life elderly were more likely to use LTC, and their expenditure on LTC was higher than their counterparts. Whether or not older people used LTC during their last year of life was significantly affected by age, sex, health insurance, household income, and living alone; however, LTC costs of the decedents were only affected by functional status, which may have been due to the reimbursement scheme of the current LTCI, which is mainly based on functional dependency level. For the survivors, having chronic diseases significantly increased the likelihood of LTC use, which was not the case for the decedents. End-of-life elderly with relatively low social economic status were more likely to use the LTC other than medical services, while the health conditions affected their medical uses most significantly. CONCLUSION: The study findings provide key information for predicting demand related to the increasing LTC needs of Korean older people at the end of life.
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Adulto , Anciano , Humanos , Enfermedad Crónica , Composición Familiar , Gastos en Salud , Seguro , Seguro de Salud , Seguro de Cuidados a Largo Plazo , Corea (Geográfico) , Cuidados a Largo Plazo , SobrevivientesRESUMEN
BACKGROUND: This study examined patient and hospital factors related to long-stay admissions in long-term care hospitals (LTCHs) among older people in Korea. METHODS: We analyzed health insurance claims data, entitlement data, and institutional administrative data from the National Health Insurance Service databases between 2010 and 2012. At the patient level, we compared characteristics of patients staying in LTCHs for over 180 days (the long-stay group) with those staying in LTCHs for less than 90 days during a calendar year. At the hospital level, we examined the general characteristics and staffing levels of the top 10% of hospitals with the highest proportion of patients whose length of stay (LOS) was 180+ days (the hospitals with long-stay patients) and compared them with the top 10% of hospitals with the highest proportions of patients whose LOS was less than 90 days (hospitals with shorter-stay patients). RESULTS: The long-stay group accounted for about 40% of all LTCH patients. People in the group were more likely to be women, aged 80+, living alone, and experiencing more than two health conditions. Compared to the hospitals with shorter-stay patients, those with long-stay patients were more likely to be occupied by patients with behavior problems and/or impaired cognition, owned by corporate or local governments, have more beds and a longer period of operation, and deliver services with lower staffing levels. CONCLUSION: This study found long-stay older people in LTCHs and those in LTCHs with high proportions of long-stay older patients had several distinct characteristics compared to their counterparts designated in this study. Patient and hospital characteristics need to be considered in policies aiming to resolve long-stay admissions problems in LTCHs.
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Femenino , Humanos , Cognición , Seguro de Salud , Corea (Geográfico) , Tiempo de Internación , Cuidados a Largo Plazo , Programas Nacionales de SaludRESUMEN
BACKGROUND: Many studies have explained regional disparities in health by socioeconomic status and healthcare resources, focusing on differences between urban and rural area. However some cities in Korea have the highest cardiovascular mortality, even though they have sufficient healthcare resources. So this study aims to confirm three hypotheses: (1) there are also regional health disparities between cities not only between urban and rural area, (2) it has different regional risk factors affecting cardiovascular mortality whether it is urban or rural area, (3) Besides socioeconomic and healthcare resources factors, there are remnant factors that affect regional cardiovascular mortality such as health behavior and physical environment. METHODS: The subject of this study is 227 local authorities (si, gun, gu). They were categorized into city (gu and si consisting of urban area) and non-city (gun consisting of rural area), and the city group was subdivided into 3 parts to reflect relative different city status: city 1 (Seoul, Gyeonggi cities), city 2 (Gwangyeoksi cities), and city 3 (other cities). We compared their mortalities among four groups by using analysis of variance analysis. And we explored what had contributed to it in whole authorities, city and non-city group by using multiple regression analysis. RESULTS: Cardiovascular mortality is highest in city 2 group, lowest in city 1 group and middle in non-city group. Socioeconomic status and current smoking significantly increase mortality regardless of group. Other than those things, in city, there are some factors associated with cardiovascular mortality: walking practice(-), weight control attempt(-), deficiency of sports facilities(+), and high rate of factory lot(+). In non-city, there are other factors different from those of city: obesity prevalence(+), self-perceiving obesity(-), number of public health institutions(-), and road ratio(-). CONCLUSION: To reduce cardiovascular mortality and it's regional disparities, we need to consider differentiated approach, respecting regional character and different risk factors. Also, it is crucial to strengthen local government's capacity for practicing community health policy.
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Enfermedades Cardiovasculares , Atención a la Salud , Conductas Relacionadas con la Salud , Política de Salud , Disparidades en el Estado de Salud , Corea (Geográfico) , Mortalidad , Obesidad , Salud Pública , Características de la Residencia , Factores de Riesgo , Humo , Fumar , Clase Social , Deportes , CaminataRESUMEN
OBJECTIVES: This study explored multidimensional factors related to obesity by dividing them into individual and environmental factors, and performed multilevel analysis to investigate community environmental effects. METHODS: Data from the 2011 and 2012 Community Health Surveys were used for the analysis. Community-level variables, constructed from various regional statistics, were included in the model as environmental factors. Respondents with body mass index (BMI)> or =25 were defined as obese, and a multilevel logistic regression analysis was conducted to analyze individual and environmental factors related to obesity. Moreover, a stratified analysis was conducted to compare factors related to obesity between men and women. RESULTS: Of 337,136 samples, 82,887 (24.6%) were obese, with BMI> or =25. Sociodemographic characteristics at the individual level were mostly significantly related to obesity; however, while there were more obese men subjects among those with high socioeconomic status, there were more obese women among those with low socioeconomic status. There were fewer obese respondents among those who regularly walked and more obese respondents among those who reported short sleep duration or were highly stressed. At the community level, people living in areas with high socioeconomic status, high satisfaction with safety and public transportation, and high accessibility to sports facilities in their community had lower obesity risks. CONCLUSIONS: Community-level environmental factors affected obesity, especially perceived community environment, more significant than physical environment. Thus, it is necessary to develop effective obesity prevention and management strategies by considering potential community environmental factors that affect obesity.
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Adulto , Femenino , Humanos , Masculino , Índice de Masa Corporal , Encuestas Epidemiológicas , Modelos Logísticos , Análisis Multinivel , Obesidad , Clase Social , Deportes , Transportes , Encuestas y CuestionariosRESUMEN
OBJECTIVES: The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea. METHODS: We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners. RESULTS: The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010. CONCLUSIONS: We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.
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Adulto , Anciano , Humanos , Persona de Mediana Edad , Adulto Joven , Atención a la Salud/economía , Gastos en Salud/estadística & datos numéricos , Encuestas Nutricionales , República de CoreaRESUMEN
There are serious problems concerning the inadequate prescription of antibiotics and overuse of injections in primary care. However, the determinants of prescription patterns in Korea are not well-documented. To examine the area characteristics affecting the prescription of antibiotics and injections in primary care practices in the treatment of respiratory tract infections (RTIs), a nationwide cross-sectional study was performed in all 250 administrative districts of Korea. The outcome was modeled as a binary variable: over-prescription or not compared with the nation-wide average. Over-prescription of antibiotics was associated with the ratio of specialists to general physicians and over-prescription in previous years in the area (adjusted odds ratio [aOR], 4.8; 95% confidence interval [CI] 1.5-14.8; and aOR, 12.0; 95% CI 5.5-25.9, respectively). Over-use of injections was associated with younger population, urban living and the number of hospital beds in the area (aOR, 0.2; 95% CI 0.1-0.4; aOR, 0.3; 95% CI 0.1-0.8; and aOR, 0.4, 95% CI 0.2-0.9; respectively). There were differences in the prescribing patterns in different districts; prescription patterns were affected more by supply factors than by demand factors. Highly competitive medical environment associated with supply factors is a significant determinant of prescription patterns in Korea.
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Femenino , Humanos , Masculino , Antibacterianos/uso terapéutico , Estudios Transversales , Hospitales , Prescripción Inadecuada , Oportunidad Relativa , Pautas de la Práctica en Medicina , Atención Primaria de Salud , Infecciones del Sistema Respiratorio/tratamiento farmacológicoRESUMEN
OBJECTIVES: The purpose of this study was to examine the impact of Diagnosis-Related Group (DRG)-based payment on the length of stay and the number of outpatient visits after discharge in for patients who had undergone caesarean section. METHODS: This study used the health insurance data of the patients in health care facilities that were paid by the Fee-For-Service (FFS) in 2001-2004, but they participated in the DRG payment system in 2005-2007. In order to examine the net effects of DRG payment, the Difference-In-Differences (DID) method was adopted to observe the difference in health care utilization before and after the participation in the DRG payment system. The dependent variables of the regression model were the length of stay and number of outpatient visits after discharge, and the explanatory variables included the characteristics of the patients and the health care facilities. RESULTS: The length of stay in DRG-paid health care facilities was greater than that in the FFS-paid ones. Yet, DRG payment has no statistically significant effect on the number of outpatient visits after discharge. CONCLUSIONS: The results of this study that DRG payment was not effective in reducing the length of stay can be related to the nature of voluntary participation in the DRG system. Only those health care facilities that are already efficient in terms of the length of stay or that can benefit from the DRG payment may decide to participate in the program.
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Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Adulto Joven , Atención Ambulatoria/economía , Cesárea/economía , Grupos Diagnósticos Relacionados/economía , Planes de Aranceles por Servicios/economía , Revisión de Utilización de Seguros , Tiempo de Internación/economíaRESUMEN
OBJECTIVES: The purpose of this study was to analyze the effect of outpatient cost-sharing on health care utilization by the elderly. METHODS: The data in this analysis was the health insurance claims data between July 1999 and December 2008 (114 months). The study group was divided into two age groups, namely 60-64 years old and 65-69 years old. This study evaluated the impact of policy change on office visits, the office visits per person, and the percentage of the copayment-paid visits in total visits. Interrupted time series and segmented regression model were used for statistical analysis. RESULTS: The results showed that outpatient cost-sharing decreased office visits, but it also decreased the percentage of copayment-paid visits, implying that the intensity of care increased. There was little difference in the results between the two age groups. But after the introduction of the coinsurance system for those patients under age 65, office visits and the percentage of copayment-paid visits decreased, and the 60-64 years old group had a larger decrease than the 65-69 years old group. CONCLUSIONS: This study evaluated the effects of outpatient cost-sharing on health care utilization by the aged. Cost sharing of the elderly had little effect on controlling health care utilization.
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Anciano , Humanos , Persona de Mediana Edad , Factores de Edad , Seguro de Costos Compartidos/economía , Servicios de Salud/economía , Revisión de Utilización de Seguros , Visita a Consultorio Médico/economíaRESUMEN
BACKGROUND: CRC is an ideal target for population screening because it is a prevalent disease with an identifiable precursor lesion. This study was performed for the purpose of comparing cost-effectiveness of CRC screening strategies. METHODS: The natural history of a simulated cohort of 50- year-old Koreans in the general population was modeled with and without CRC screening until age 80 years. We evaluated 16 different screening strategies with Markov model. Cases of positive screening test results were worked up with a colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Our main outcome measurements were discounted lifetime costs, life expectancy and incremental cost-effectiveness (CE) ratio, comparing 16 different CRC screening strategies. RESULTS: In base-case analysis, compliance was assumed to be 60% with the initial screen and 80% with follow-up or surveillance colonoscopy. The non-dominated strategies were colonoscopy every 10 years (COL10), colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). Strategies that only included sigmoidoscopy were generally not regarded as non-dominated strategies, but sigmoidoscopy every 5 years (SIG5) showed similar cost and effects as COL10 while sigmoidoscopy every 3 years (SIG3) had similar results as COL5. Other strategies recommended by the expert panel, such as sigmoidocopy plus colon study every 5 years were less cost-effective than the alternatives. CONCLUSION: Colonoscopy is the most cost-effective strategy in Korea for colorectal cancer screening. Unfortunately, the number of physicians skilled enough to perform colonoscopy is not enough to meet the demands of screening for colorectal cancer in average-risk adults. Therefore, we consider alternative strategies such as SIG5 or SIG3.