The Dual Labor Market and Workers' Health Inequality in South Korea.

OBJECTIVE: We investigated how worker health inequality is potentially linked to the dual labor market in South Korea. METHODS: Using the data from the fifth Korean Working Conditions Survey, we analyzed the data from 21,088 paid workers. We used logistic regression analyses to assess whether employment type or company size had a significant effect on workers' physical and mental health and work-related injuries. RESULTS: Workers' health status was significantly associated with employment type and company size. Nonstandard workers had higher rates of musculoskeletal diseases or injuries, and their self-rated health and psychological well-being were lower than standard workers. Company size showed a significant correlation only for work-related injuries. CONCLUSIONS: The structure of inequality in Korea's labor market according to employment type and company size seems to be affecting the health and safety of workers.

The Effect of Job Demands, Job Resources, and Musculoskeletal Complaints on Presenteeism Among the Dependent Self-employment Workers in Korea: Testing of a Mediation and Moderation Model.

OBJECTIVES: We tested the effects of job demands on presenteeism to investigate the mediation of musculoskeletal complaints (MSCs) and the moderating effects of job resources among dependent self-employment (DSE) workers in Korea. METHODS: Using data from the fifth Korean Working Conditions Survey, we analyzed 2252 workers, and a two-step regression analysis was used to test the mediated effect of MSCs and moderated the effect of job resources on the relationship between job demand and presenteeism. RESULTS: Musculoskeletal complaints mediate the relationship between job demands and presenteeism. Job control moderated the relationship between MSCs and presenteeism among the job resources. However, the conditional indirect effect of job demands on presenteeism through MSCs was independent of job resource levels among DSE workers. CONCLUSIONS: Various strategies are needed to address MSCs and enhance job resources for DSE workers, which might diminish the negative effect of job demands on presenteeism.

Who Benefits from the Fixed Copayment of Medical and Pharmaceutical Expenditure among the Korean Elderly?

The Korean National Health Insurance system imposes a 30% coinsurance for outpatient medical care and prescription drugs; however, at the age of 65, the coinsurance model changes to a copayment model that offers lower fees for the elderly. Thus, this study aimed to investigate the influence of the copayment model for outpatient visits and prescription drugs on healthcare utilization among the Korean elderly. We compared total outpatient visits, total prescriptions, and out-of-pocket expenses between a case group with copayment reduction (65 years or older) and a control group without any reduction (64 years or younger). We obtained secondary data collected from seven waves of the Korea Health Panel Survey (2010-2016). Outpatient visits increased exclusively in the case group among those with lower income. After adjusting for covariates, the results of the difference-in-differences analysis showed that, compared to the control group, there was a significant increase in outpatient visits among individuals with lower income in the case group. Our study shows that cost sharing changes affect Korean patients with different income levels in different ways.

Effects of Academic Motivation on Clinical Practice-Related Post-Traumatic Growth among Nursing Students in South Korea: Mediating Effect of Resilience.

Post-traumatic growth (PTG) refers to personal growth that occurs after experiencing challenges. For many nursing students, PTG could occur during their clinical practice. Academic motivation and resilience could help students to overcome these traumatic clinical experiences and possibly achieve PTG. This study examined the relationships between nursing students' academic motivation and resilience leading to post-traumatic growth. A total of 291 nursing students from three South Korean nursing colleges participated in this cross-sectional study. Self-report questionnaire data were analyzed using t-tests, ANOVA, correlations, and hierarchical multiple linear regressions. Intrinsically motivated students' PTG scores were significantly higher compared to extrinsically motivated students (t = 4.62, p < 0.001). Resilience scores showed similar results (t = 3.81, p < 0.001). Significant total, direct, and indirect effects of academic motivation on resilience and PTG were found. In addition, resilience mediated 40.9% of the relationship between academic motivation and PTG. Nursing students with intrinsic academic motivation were more likely to achieve high PTG scores, and resilience mediated the relationship between academic motivation and PTG. It is suggested that the importance of academic motivation must be considered in the early stages of university-level nursing education to increase retention rates of nursing students.

The impact of differential cost sharing of prescription drugs on the use of primary care clinics among patients with hypertension or diabetes.

OBJECTIVES: Since 2011, the Korean government has implemented differential cost sharing to increase the utilization of primary care clinics for the management of chronic diseases. The objective of this study was to examine the impact of the prescription drug cost-sharing increase on outpatients' selection of the medical care institution. STUDY DESIGN: This was a pre-post comparison study. METHODS: Participants were 34,842 patients with hypertension and 13,886 patients with type 2 diabetes, who were all newly prescribed. Data were collected via national health insurance system claims. The change in the main medical care institution for disease management before and after the cost sharing policy was analyzed using logistic regression analysis. RESULTS: Nearly 18% of participants with hypertension and 22% of participants with diabetes used tertiary care or general hospital outpatient services before the policy was implemented. After the increased prescription drug coinsurance rate (by 10-20%), the likelihood of selecting primary care clinics or small hospitals was significantly higher among patients with hypertension within 1 year (odds ratio [95% confidence interval] = 1.29 [1.19-1.41]) than before. However, the policy effect was not significant among patients with diabetes. CONCLUSIONS: The cost sharing policy was effective in inducing patients with hypertension to manage their chronic disease in primary care institutions; however, this was not true for patients with diabetes. The assurance of high-quality disease management services and low out-of-pocket expenses may be needed to encourage patients with chronic diseases to use primary care clinics.

Exposure to Adverse Social Behavior in the Workplace and Sickness Presenteeism among Korean Workers: The Mediating Effects of Musculoskeletal Disorders.

Adverse social behavior (ASB) by colleagues or superiors in the workplace is considered highly stressful for workers in South Korea. The authors investigate the mechanism by which ASB reduces productivity (measured in terms of sickness presenteeism (SP)), by examining the potential mediating role of musculoskeletal disorders (MSDs). All data are derived from the fourth Korean Working Conditions Survey, which investigated a representative sample of the working population. The authors analyze their general characteristics (age, gender, income, and education), work-related factors (job type, occupational ergonomic risk, job resource, employment contract, work schedule, working hour, and job demand), and health-related factors (self-rated health and MSDs). The authors use a two-step regression analysis to estimate the direct effect of ASB on SP and the indirect effect of SP via MSDs. The authors find that MSDs mediate 16.7% of the total effect of ASB on SP. When employment type and job conditions are considered, the role of the mediating variable in the group with a permanent contract, no shift or night work, and high working time is greater than the counterpart of each variable. Various strategies are needed to address MSDs according to the working environment, which might help limit the negative impact of ASB on SP.

The Impact of Organizational Commitment and Nursing Organizational Culture on Job Satisfaction in Korean American Registered Nurses.

PURPOSE: This study aimed to describe the perceived level of organizational commitment and organizational culture of Korean American Registered Nurses (KARNs) and to investigate predictors of job satisfaction. DESIGN: A total of 163 KARNs working in U.S. hospitals responded to a Web survey. Descriptive analysis, t test, analysis of variance, and stepwise regressions were used for data analysis. RESULTS: KARNs reported moderate levels of job satisfaction (3.5 ± 0.58). Job satisfaction was positively correlated with both organizational commitment ( r = .85, p < .001) and culture ( r = .66, p < .001). KARNs who were aged ≥50, married, hospital-employed, had longer nursing experience, and experienced turnover at least once were more likely to report higher job satisfaction compared with other nurses. Organizational commitment, culture, marital status, and workplace were significant predictors of and explained 76.8% of the variance in job satisfaction. CONCLUSION: This study provides evidence to help nursing managers and health policy makers develop educational programs aimed at enhancing job satisfaction and retention of KARNs.