Worsening of health disparities across COVID-19 pandemic stages in Korea.

OBJECTIVES: With the end of the coronavirus disease 2019 (COVID-19) pandemic, the health outcomes of this disease in Korea must be examined. We aimed to investigate health outcomes and disparities linked to socioeconomic status during the COVID-19 pandemic in Korea and to identify risk factors for hospitalization and mortality. METHODS: This nationwide retrospective study incorporated an analysis of individuals with and without COVID-19 in Korea between January 1, 2020 and December 31, 2022. The study period was divided into 4 stages. Prevalence, hospitalization, mortality, and case-fatality rates were calculated per 100,000 population. Multivariate logistic regression was performed to identify risk factors for COVID-19 hospitalization and mortality. RESULTS: Overall, the incidence rate was 40,601 per 100,000 population, the mortality rate was 105 per 100,000 population, and the case-fatality rate was 259 per 100,000 cases. A total of 12,577,367 new cases (24.5%) were recorded in stage 3 and 8,979,635 cases (17.5%) in stage 4. Medical Aid recipients displayed the lowest 3-year cumulative incidence rate (32,737 per 100,000) but the highest hospitalization (5,663 cases per 100,000), mortality (498 per 100,000), and case-fatality (1,521 per 100,000) rates. Male sex, older age, lower economic status, non-metropolitan area of residence, high Charlson comorbidity index, and disability were associated with higher risk of hospitalization and death. Vaccination was found to reduce mortality risk. CONCLUSIONS: As the pandemic progressed, surges were observed in incidence, hospitalization, and mortality, exacerbating disparities associated with economic status and disability. Nevertheless, Korea has maintained a low case-fatality rate across all economic groups.

Reduced economic disparity in biologics use for psoriasis after introducing the reducing copayment program.

Biologics for psoriasis are efficient and safe, but very expensive. We investigated the association of the reducing copayment program (RCP) with changes in biologics use patterns depending on the income levels of patients with moderate-to-severe psoriasis. This nationwide cohort study included patients identified as having moderate-to-severe psoriasis between 2014 and 2020. Logistic regression models were used to estimate the odds ratio for the use of biologics according to income levels. Among 57,139 patients with moderate-to-severe psoriasis, 3464 (6.1%) used biologics for psoriasis from 2014 to 2020. After the introduction of RCP in 2017, the proportion of patients with moderate-to-severe psoriasis using biologics rapidly increased from 5.0% in 2016 to 19.2% in 2020; the increase was more remarkable in patients with the lowest or mid-low income compared to those with Medical Aid. Drug survival of biologics was higher in patients with the highest income before the RCP, but became comparable between those with high and low incomes after RCP introduction. The introduction of RCP was associated with an increased use of biologics in patients with moderate-to-severe psoriasis of all income levels; however, the effect was more pronounced in low-income patients. The RCP may contribute to alleviating the disparity in access to biologics.

Mortality After Acute Coronary Syndrome in Human Immunodeficiency Virus Infection with Optimal Adherence: A Nationwide Study.

BACKGROUND: There have been few studies on the outcome of acute coronary syndrome (ACS) in human immunodeficiency virus (HIV) infection in the era when antiretroviral therapy (ART) is generalized and most of them have achieved viral suppression. Using claims data, we aimed to assess the mortality after atherosclerotic cardiovascular events in people with HIV (PWH) who maintain optimal adherence to ART. MATERIALS AND METHODS: We used claims data from the National Health Insurance of the Korea to confirm newly diagnosed PWH from 2009 to 2019, and measured ART adherence. ACS and mortality were confirmed in PWH who showed optimal adherence to ART. RESULTS: Among 7,100 PWH with optimal adherence and during 27,387 person-year of follow-up duration, ACS was confirmed in 140 (2.0%) cases, which was 1.3 times greater than statistics of the Korean general population (511.0 vs. 383.1 per 100,000). Acquired immunodeficiency syndrome, hypertension, dyslipidemia, and diabetes mellitus were associated with the development of ACS in PWH with optimal adherence. Mortality was confirmed in 10 cases, which is 7.1% overall and 2.9% when limited to myocardial infarction. It was comparable with the mortality rate of the Korean general population after myocardial infarction (8.9%). CONCLUSION: ACS prevalence was higher in PWH even when optimal adherence was maintained. However, mortality after ACS was comparable to that in the HIV-negative population.

Anomalous excess noise behavior in thick Al0.85Ga0.15As0.56Sb0.44 avalanche photodiodes.

Al0.85Ga0.15As0.56Sb0.44 has recently attracted significant research interest as a material for 1550 nm low-noise short-wave infrared (SWIR) avalanche photodiodes (APDs) due to the very wide ratio between its electron and hole ionization coefficients. This work reports new experimental excess noise data for thick Al0.85Ga0.15As0.56Sb0.44 PIN and NIP structures, measuring low noise at significantly higher multiplication values than previously reported (F = 2.2 at M = 38). These results disagree with the classical McIntyre excess noise theory, which overestimates the expected noise based on the ionization coefficients reported for this alloy. Even the addition of 'dead space' effects cannot account for these discrepancies. The only way to explain the low excess noise observed is to conclude that the spatial probability distributions for impact ionization of electrons and holes in this material follows a Weibull-Fréchet distribution function even at relatively low electric-fields. Knowledge of the ionization coefficients alone is no longer sufficient to predict the excess noise properties of this material system and consequently the electric-field dependent electron and hole ionization probability distributions are extracted for this alloy.

Increased 10-Year Prevalence of Huntington's Disease in South Korea: An Analysis of Medical Expenditure Through the National Healthcare System.

BACKGROUND AND PURPOSE: This study aimed to determine the updated 10-year prevalence of Huntington's disease (HD) in South Korea and the medical and economic burdens across the duration of the disease. METHODS: Data from the National Health Insurance database during 2010-2019 were analyzed. We identified HD cases using predefined criteria. Information on age at diagnosis, sex, and common nonneurological comorbidities were collected. We analyzed individual patterns of the use of medical services and yearly medical expenditure. Incidence rates, 10-year prevalence rates, and longitudinal medical expenditure changes were assessed. RESULTS: New patients with HD (average=152.10) were detected every year, with an annual incidence of 0.29 per 100,000. The estimated 10-year prevalence of HD was 2.2 per 100,000. The most common ages at the time of diagnosis were 50-59 years (23.3%). In 2019, 56.4% of patients with HD were followed-up at referral or general hospitals, and 32.2% were managed at long-term-care hospitals. The annual medical cost for an individual was KRW 6,569,341±895,097 (mean±SD) (mean≈USD 5,653). Medical expenditure was the highest in those aged 60-79 years, and lowest in those younger than 30 years. However, in all age groups, the annual medical expenditure was highest during the 9 years following a diagnosis. CONCLUSIONS: This study found that the actual prevalence of HD in South Korea was higher than previously thought and that patients are in a situation with high medical expenditure that persists over time.

Work Restrictions for Healthcare Personnel with Potential In-hospital Exposure to SARS-CoV-2: Experience at a Tertiary Hospital.

Applying work restrictions for asymptomatic healthcare personnel (HCP) with potential exposure to coronavirus disease 2019 (COVID-19) is recommended to prevent transmission from potentially contagious HCP to patients and other HCP. However, it can lead to understaffing, which threatens the safety of both patients and HCP. We evaluated 203 COVID-19 exposure events at a single tertiary hospital from January 2020 to June 2021. A total of 2,365 HCP were potentially exposed, and work restrictions were imposed on 320 HCP, leading to the loss of 3,311 working days. However, only one of the work-restricted HCP was confirmed with COVID-19. During the study period, the work restriction measures might be taken excessively compared to their benefit, so establishing more effective standards for work restriction is required.

Power of universal health coverage in the era of COVID-19: A nationwide observational study.

BACKGROUND: During the COVID-19 pandemic, South Korea has achieved perfect universal health coverage (UHC)-all Koreans receive UHC regardless of their socioeconomic status. The current study investigated whether socioeconomic disparities remained in COVID-19 health outcomes under UHC. METHODS: This retrospective, observational study included all 7,590 confirmed COVID-19 patients in South Korea up to 15 May 2020. We used the official medical claim database, and socioeconomic status was estimated by insurance type (National Health Insurance Service [NHIS] beneficiaries and Medical Aid [MA] recipients). Type of insurance is a well-known indicator of socioeconomic status. Prevalence (per one million), mortality rate (per one million), and case fatality rate were calculated. To determine the factors associated with case fatality rate, multivariable logistic regressions were performed. FINDINGS: The nationwide prevalence, mortality rate, and case fatality rate of COVID-19 was 144•4, 4•3 and 3•0%, respectively. MA recipients had higher prevalence (424•3 vs 136.3), mortality rate (28•3 vs 3•6), and case fatality rate (6•7 vs 2•7) than NHIS beneficiaries. However, the adjusted analysis showed that the type of insurance was not associated with higher odds of case fatality. INTERPRETATION: We found socioeconomic disparities in COVID-19 prevalence and fatality despite UHC. However, disparities in fatality were not due to socioeconomic status, but due to the poor underlying health conditions of the people. This result can be explained by a combination of UHC, rapid early testing and treatment, transmission-reducing behaviours, and regional preparedness. FUNDING: This research did not receive any funding.

The Psychological Burden of COVID-19 Stigma: Evaluation of the Mental Health of Isolated Mild Condition COVID-19 Patients.

BACKGROUND: The objective of this article is to assess the mental health issues of the mild condition coronavirus disease 2019 (COVID-19) patients admitted to a community treatment center (CTC) in Korea. METHODS: A total of 107 patients admitted to a CTC were included as the study population, and their mental health problems including depression (patient health questionnaire-9), anxiety (generalized anxiety disorder scale-7), post-traumatic stress disorder (PTSD) (PTSD checklist-5) and somatic symptoms (by patient health questionnaire-15) were evaluated every week during their stay. The stigma related to COVID-19 infection was evaluated with an adjusted version of the Middle East respiratory syndrome (MERS) stigma scale. RESULTS: During the first week of isolation, the prevalence of more-than-moderate depression was 24.3%, more-than-moderate anxiety was 14.9%, more-than-moderate somatic symptoms was 36.5% and possible PTSD was 5.6% of total population. For depression and anxiety, previous psychiatric history and stigma of COVID-19 infection were significant risk factors. For PTSD, previous psychiatric history and stigma of COVID-19 infection as well as total duration of isolation were found to be significant risk factors. Prevalence of depression, anxiety and possible PTSD remained similar across the four weeks of observations, though the prevalence of severe depression, increased after four weeks of stay. Somatic symptoms seemed to decrease during their stay. CONCLUSION: The results suggest that social mitigation of COVID-19 related stigma, as well as care of patients with pre-existing mental health problems are important mental health measures during this crisis period. It is also important that clinical guidelines and public health policies be well balanced over the protection of the public and those quarantined to minimize the negative psychosocial consequences from isolation of the patients.

Operating Protocols of a Community Treatment Center for Isolation of Patients with Coronavirus Disease, South Korea.

Most persons with confirmed coronavirus disease (COVID-19) have no or mild symptoms. During the COVID-19 pandemic, communities need efficient methods to monitor asymptomatic patients to reduce transmission. We describe the structure and operating protocols of a community treatment center (CTC) run by Seoul National University Hospital (SNUH) in South Korea. SNUH converted an existing facility into a CTC to isolate patients who had confirmed COVID-19 but mild or no symptoms. Patients reported self-measured vital signs and symptoms twice a day by using a smartphone application. Medical staff in a remote monitoring center at SNUH reviewed patient vital signs and provided video consultation to patients twice daily. The CTC required few medical staff to perform medical tests, monitor patients, and respond to emergencies. During March 5-26, 2020, we admitted and treated 113 patients at this center. CTCs could be an alternative to hospital admission for isolating patients and preventing community transmission.

Selecting coronavirus disease 2019 patients with negligible risk of progression: early experience from non-hospital isolation facility in Korea.

BACKGROUND/AIMS: As the novel coronavirus (coronavirus disease 2019 [COVID-19]) outbreak progresses rapidly, staying home is recommended for suspected patients; however, the safety of this recommendation is uncertain. In Korea, non-hospital facilities called "living and treatment centers (LTCs)" have been established since 5 March 2020. The LTCs provided a unique opportunity to evaluate the safety of selection criteria for low-risk groups. METHODS: Between 5 March and 9 April 2020, patients with COVID-19 who met the following criteria were admitted to the LTC; alert, age below 65 years old, no underlying disease or well-controlled underlying disease, body temperature below 38.0°C, whether taking antipyretics or not, and no dyspnea. Patients were closely observed by doctors or nurses' interviews twice a day and transferred to hospitals when symptoms worsened. RESULTS: A total of 113 patients were admitted to the LTC; 52.2% were female, with a median age of 25 years (interquartile range, 21.5 to 39.5). Of 113 patients, 54 (47.8%) were asymptomatic at diagnosis, and 15 (13.3%) had no symptoms until they were released from isolation. During the follow-up period, two (1.8%) patients were transferred to a hospital but did not progress to severe status during hospitalization. CONCLUSION: The risk of progression was negligible in COVID-19 patients who met the admission criteria for LTC at the time of diagnosis. LTCs could be a safe alternative considering shortage of hospital beds.

Influence of trust on two different risk perceptions as an affective and cognitive dimension during Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea: serial cross-sectional surveys.

OBJECTIVES: This study aimed to assess the affective and cognitive risk perceptions in the general population of Middle East respiratory syndrome (MERS) during the 2015 MERS coronavirus (MERS-CoV) outbreak in South Korea and the influencing factors. DESIGN: Serial cross-sectional design with four consecutive surveys. SETTING: Nationwide general population in South Korea. PARTICIPANTS: Overall 4010 respondents (aged 19 years and over) from the general population during the MERS-CoV epidemic were included. PRIMARY AND SECONDARY OUTCOME MEASURES: The main outcome measures were (1) affective risk perception, (2) cognitive risk perception, and (3) trust in the government. Multivariate logistic regression models were used to identify factors (demographic, socioeconomic, area and political orientation) associated with risk perceptions. RESULTS: Both affective and cognitive risk perceptions decreased as the MERS-CoV epidemic progressed. Proportions of affective risk perception were higher in all surveys and slowly decreased compared with cognitive risk perception over time. Females (adjusted OR (aOR) 1.72-2.00; 95% CI 1.14 to 2.86) and lower self-reported household economic status respondents were more likely to perceive the affective risk. The older the adults, the higher the affective risk perception, but the lower the cognitive risk perception compared with younger adults. The respondents who had low trust in the government had higher affective (aOR 2.19-3.11; 95 CI 1.44 to 4.67) and cognitive (aOR 3.55-5.41; 95 CI 1.44 to 9.01) risk perceptions. CONCLUSIONS: This study suggests that even if cognitive risk perception is dissolved, affective risk perception can continue during MERS-CoV epidemic. Risk perception associating factors (ie, gender, age and self-reported household economic status) appear to be noticeably different between affective and cognitive dimensions. It also indicates that trust in the government influences affective risk perception and cognitive risk perception. There is a need for further efforts to understand the mechanism regarding the general public's risk perception for effective risk communication.

Emotion dysregulation in idiopathic rapid eye movement sleep behavior disorder.

STUDY OBJECTIVES: To characterize emotion regulation strategies in patients with idiopathic REM sleep behavior disorder (iRBD) and to explore whether these strategies are associated with clinical symptoms. METHODS: In this cross-sectional multicenter study, a total of 94 polysomnography-confirmed iRBD patients (mean age, 67.6 years; men, 56%) and 50 healthy controls (mean age, 65.4 years; men, 48%) completed the Cognitive Emotion Regulation Questionnaire (CERQ), the Korean version of the RBD questionnaire-Hong Kong (RBDQ-KR), the Buss-Durkee Hostility Inventory (BDHI), the second edition of the Beck Depression Inventory (BDI-II), and the Korean version of the Montreal Cognitive Assessment (MoCA-K). RESULTS: The iRBD group had lower CERQ adaptive scores than the control group, whereas the CERQ maladaptive scores were not significantly different between the groups. Among the CERQ adaptive subscales, the scores for positive refocusing, refocusing on planning, and positive reappraisal were significantly lower in the iRBD group than in the control group. Higher CERQ adaptive scores were correlated with lower scores on RBDQ-KR factor 1 (dream-related) and the BDI-II and higher MoCA-K scores but were not correlated with RBDQ-KR factor 2 (behavioral manifestation) or BDHI scores. Among the dream content-related items of RBDQ-KR factor 1, the CERQ adaptive score was associated only with frequent nightmares. No correlation was found between CERQ maladaptive scores and any variable except for a positive correlation with BDI-II scores. CONCLUSIONS: Our results provide evidence of emotion regulation deficits in iRBD patients. Furthermore, these results were linked to dream-related factors, especially nightmares, along with depressive symptoms and cognitive impairment.

How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women.

OBJECTIVES: Access to a delivery unit is a major factor in determining maternal morbidity and mortality. However, there is little information about the optimal access time to a delivery unit. This study aimed to establish the optimal hospital access time (OHAT) for pregnant women in South Korea. DESIGN: Nationwide cross-sectional study. SETTING: We used the National Health Insurance System database of South Korea. PARTICIPANTS: We analysed the data of 371 341 women who had experienced pregnancy in 2013. PRIMARY AND SECONDARY OUTCOME MEASURES: Access time to hospital was defined as the time required to travel from the patient's home to the delivery unit. The incidence of obstetric complications was plotted against the access time to hospital. Change-point analysis was performed to identify the OHAT by determining a point wherein the incidence of obstetric complications changed significantly. As a final step, the risk of obstetric complications was compared by type among pregnant women who lived within the OHAT against those who lived outside the OHAT. RESULTS: The OHAT associated with each adverse pregnancy outcomes were as follows: inadequate prenatal care, 41-50 min; preeclampsia, 51-60 min; placental abruption, 51-60 min; preterm delivery, 31-40 min; postpartum transfusion, 31-40 min; uterine artery embolisation, 31-40 min; admission to intensive care unit, 31-40 min; and caesarean hysterectomy, 31-40 min. Pregnant women who lived outside the OHAT had significantly higher risk for obstetric complications than those who lived within the OHAT. CONCLUSIONS: Our results showed that the OHAT for each obstetric complication ranged between 31 and 60 min. The Korean government should take the OHAT under consideration when establishing interventions for pregnant women who live outside OHAT to reduce maternal morbidity and mortality.

Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea.

BACKGROUND: Although effective care for type 2 diabetes (T2DM) is well known, considerable inadequate care has been still existed. Variations in achievement of the recommended quality indicators inT2DM care among small areas are not well known in Korea. This study examined the quality of care T2DM care and its geographical variations. METHODS: We used the national health insurance database and national health screening database. Seven quality indicators were used to evaluate continuity of care (medication possession ratio), process of care (hemoglobin A1c test, lipid profile, microalbuminuria test, and eye examination), and intermediate outcome (blood pressure control, and low-density lipoprotein control). Crude and age-standardized proportions were calculated for each 252 districts in Korea. RESULTS: All quality indicators failed to achieve the recommended level. Only about 3% and 15% of the patients underwent eye examination and microalbuminuria test, respectively. Other indicators ranged from 48% to 68%. Wide variation in the quality existed among districts and indicators. Eye examination and microalbuminuria test varied the most showing tenfold (0.9%-9.2%) and fourfold (6.3%-28.9%) variation by districts, respectively. There were 32.4 and 42.7 percentage point gap between the best and the worst districts in hemoglobin A1c test and blood pressure control, respectively. CONCLUSION: Considerable proportion of T2DM patients were not adequately managed and quality of care varied substantially district to district. To improve the quality of diabetes care, it is necessary to identify the poor performance areas and establish a well-coordinated care system tailored to the need of the district.

Preventive Behavioral Responses to the 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in Korea.

This study examined the public's preventive behavioral responses during the 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in Korea and the influencing factors. Two cross-sectional telephone surveys were conducted by Gallup Korea using random digit dialing in June 2015 (n = 2004). The main outcome variables were nonpharmaceutical preventive measures (survey (1): Measures for reducing transmission (handwashing, face masks); and survey (2): Measures for avoiding contact with others). Multiple logistic regression was used to identify the factors influencing preventive behaviors. In survey (1), 60.3% of respondents reported more frequent handwashing and 15.5% reported wearing face masks at least once due to the MERS-CoV epidemic. In survey (2), 41-56% of respondents reported practicing avoidance measures. The concerned group was more likely to practice reducing transmission measures (odds ratio (OR) 4.5; 95% confidence interval (CI) 3.3-6.1) and avoidance measures (OR = 9.6; 95% CI, 6.4-14.4). The respondents who had low trust in president or ruling party had a higher practice rate of reducing transmission measures (OR = 1.7; 95% CI, 1.2-2.6) and avoidance measures (OR = 2.1; 95% CI, 1.2-3.5). Cooperative prevention measures need appropriated public concern based on effective risk communication.

General Public's Perspectives on Medical Doctors and Local Clinics in South Korea.

As patients in South Korea play the main role in choosing healthcare providers, understanding their attitudes and beliefs toward medical institutions is essential. This study evaluated the public's perspectives on doctors and local clinics. A face-to-face interview survey was conducted with 1000 participants who represent the South Korean adult population. The questionnaire consisted of four domains: personal information; trust level for nine professionals, including doctors; healthcare utilization behavior and attitudes regarding local clinics; and assessment of local clinics. The trust level of the doctor was highest (3.16 out of 4) among nine professionals. 85.3% of the participants frequently visited local clinics because of accessibility. The main reason for visiting hospitals over local clinics was the belief that doctors employed at hospitals would be better qualified. People were generally satisfied with the service of local clinics but wanted more facilities and equipment. Among six attributes of primary care, "first contact" and "accessibility" got higher scores in importance and current performance. Lastly, the participants suggested that improving the quality of doctors was most important for the reinforcement of primary care. Efforts to consider public opinion should be made before establishing healthcare policies for primary care.

Primary Care Patients' Preference for Hospitals over Clinics in Korea.

Korea is in a unique condition to observe whether patients, when equal access to the levels of health care facilities is guaranteed by the support of the national health insurance, choose the appropriate levels of health care facilities. This study was performed to investigate the primary care patients' preference for hospitals over clinics under no restriction for their choice. We used the 2011 National Inpatient Sample database of the Health Insurance Review and Assessment Service in Korea. A primary care patient was defined as a patient who visited as an outpatient in health care facilities with one of the 52 minor conditions defined by the Korean government. We found that approximately 15% of outpatient visits of the patients who were eligible for primary care in Korea happened in hospitals. In terms of cost, the outpatient visits in hospitals accounted for about 29% of total cost of outpatient visits. This arbitrary access to hospitals can lead to an inefficient use of health care resources. In order to ensure that health care facilities are stratified in terms of access as well as size and function, interventions to distribute patients to the appropriate level of care are required.

Worry experienced during the 2015 Middle East Respiratory Syndrome (MERS) pandemic in Korea.

BACKGROUND: Korea failed in its risk communication during the early stage of the Middle East Respiratory Syndrome (MERS) outbreak; consequently, it faced difficulties in managing MERS, while disease-related worry increased. Disease-related worry can help disease prevention and management, but can also have a detrimental effect. This study measured the overall level of disease-related worry during the MERS outbreak period in Korea and the influencing factors and levels of disease-related worry during key outbreak periods. METHODS: The cross-sectional survey included 1,000 adults who resided in Korea. An ordinal logistic regression was performed for the overall level of MERS-related worry, and influencing factors of worry were analyzed. A reliability test was performed on the levels of MERS-related worry during key outbreak periods. RESULTS: The overall level of MERS-related worry was 2.44. Multivariate analysis revealed that women and respondents w very poor subjective health status had higher levels of worry. Respondents with very high stress in daily life had higher levels of worry than those who reported having little stress. The reliability test results on MERS-related worry scores during key outbreak periods showed consistent scores during each period. CONCLUSION: Level of worry increased in cases having higher perceived susceptibility and greater trust in informal information, while initial stage of outbreak was closely associated with that at later stages. These findings suggest the importance of managing the level of worry by providing timely and accurate disease-related information during the initial stage of disease outbreak.

Determinants of Attitude toward the Public Health Spending and Its Relationship with Voting Behavior in the 2012 South Korean Presidential Election.

This study aimed to identify the factors influencing South Korean voters' attitudes towards increasing public expenditure on health and to identify whether the issue of healthcare expenditure influenced candidate choice in the 2012 Korean presidential election. The study used the data from a survey conducted by the Institute of Korean Politics at Seoul National University immediately following the 2012 presidential election. The survey was completed by a nationwide sample of 1,200 people aged 19 or over using a face-to-face interview method and proportional quota sampling based on sex, age, and region. About 44.3% of respondents had a positive attitude toward increasing public health expenditure. There was no significant difference by the candidate they supported (conservative Park Geun-hye or liberal Moon Jae-in). In particular, even 44.9% of conservative supporters agreed with more spending. Politically neutral respondents (OR = 1.76, 90% CI 1.22-2.54) and strong conservative party supporters (OR = 1.53, 90% CI 1.05-2.25) were more likely to support public health expenditure increase compared to strong liberal party supporters. Also, respondents who believed that the economic gap in the country was widening were 1.91 times more likely to support an increase in public health expenditures. However, the issue of health expenditure had no influence on voters' choice of presidential candidates, and in particular no negative effect of choice of the ruling (conservative) party's candidate. Our results should be interpreted with care; one possible reason for this lack of effect might be that constituents voted along partisan lines regardless of their attitude to the welfare issue; another possible explanation might be the success of the "left click strategy" of the conservative party. That is, the conservatives did not reject economic democratization or social welfare expansion. Further research should be done to explain why attitudes to health spending did not directly affect choice of candidate.