Objectives: To examine, in beneficiaries with long-term care (LTC) insurance (LTCI) with dementia in Korea, changes in cognitive function, behavioral symptoms, and physical function over time in relation to LTCI service type and to determine the 2-year effects of service type on those health outcomes.
Design: Secondary analyses of the existing LTCI data set from 2008 to 2010.
Setting: South Korea.
Participants: LTCI beneficiaries with dementia aged 65 and older (N = 31,319). Participants were divided according to the service type that they were receiving home care (HC), institutional care (IC), and combined care (CC).
Measurements: A LTC approval checklist was used to determine the level of LTCI coverage of each participant and to assess cognitive function, behavioral symptoms, and physical function. Linear mixed models and multiple regression models were used.
Results: There were significant differences in cognitive function, behavioral symptoms, and physical function at baseline between individuals receiving the three service types (P < .001) and overall improvements in those outcomes over 2 years in the three groups (P < .001). After limiting the sample to those who had received LTCI services for the full 2 years (2008–2010) and adjusting for baseline characteristics, individuals receiving HC were more likely to have better cognitive and physical function than those receiving IC or CC but were likely to have more behavioral symptoms 2 years after the LTCI enrollment (P < .001).
Conclusion: LTCI service type (HC, IC, CC) predicted cognitive function, behavioral symptoms, and physical function at 2-year follow-up in beneficiaries with dementia. Further research is necessary to examine the effect of LTC services on health outcomes in a longer observational cohort.

Cognitive function, behavioral problems, and physical function in long-term care insurance beneficiaries with dementia in South Korea: comparison of home care and institutional care services.

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.

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

보훈의료지원 제도는 보훈관계법령을 근거로 독립유공자, 국가유공자와 그 가족 및 유족들이 건강한 생활을 유지하고 필요한 진료 등을 받을 수 있도록 보훈 제도의 일환으로 확립 되었다. 국가유공자의 범위는 참전유공자, 직무수행 중 사망 또는 상해를 입은 군경, 419/518 민주화유공자 등 다양한 공훈 집단을 포함한다. 보훈의료지원의 내용은 국가에 세운 공훈이 나 그 과정에서 얻게 된 질병에 따라 정해진다. 특히, 베트남 전 참전, 국내 미군기지 또는 비무장지대 남방한계선 인접지 역 근무 중 고엽제 살포에 노출되어 관련 후유증을 가지게 된 국가유공자의 지원을 위해서는 1993년 ‘고엽제 후유의증 등 환자지원 및 단체설립에 관한 법률’이 제정되었다. 이후 실시 된 역학조사 결과 인과관계가 밝혀진 질환에 대한 의료지원이 본격적으로 시작되었으며, 지원대상은 후유(의)증을 가진 본인 뿐만 아니라 고엽제의 영향으로 장애를 가지게 된 2세까지 아 우르고 있다. 국가보훈처에 따르면 2018년말 현재 전체 보 훈 인구는 847,078명이고, 전체의료비는 1조 1,234억에 이르 렀다. 보훈환자들은 의료비 중 본인부담금의 30~100%를 감 면 받고 있으며, 국가가 지정한 보훈병원과 위탁병의원 등 보 훈 지정 의료기관을 이용할 때 비용 감면 혜택을 보다 편리하 게 받을 수 있다. 보훈 지정 의료기관으로는 6개의 보훈병원 과 320여 개의 위탁 병의원이 운영되고 있다. 현재 보훈환자의 의약품 사용에 대한 연구는 매우 부족한 ABSTRACT

/pdf/prescription-drug-use-behavior-and-influence-factors-in-579mfl28ha.pdf

Prescription Drug Use Behavior and Influence Factors in Veteran Patients from the Perspective of Veterans

In 2019, the Constitutional Court of South Korea ruled that the anti-abortion provisions in the Criminal Act, which criminalize abortion, do not conform to the Constitution. This decision will lead to a total reversal of doctors’ legal duty from the obligation to refuse abortion services to their requirement to provide them, given the Medical Service Act that states that a doctor may not refuse a request for treatment or assistance in childbirth. I argue, confined to abortion services in Korea that will take place in the near future, that doctors should be granted the legal right to exercise conscientious objection to abortion. Considering that doctors in Korea have been ethically and legally obligated to refrain from abortions for many years, imposing a universal legal duty to provide abortions that does not allow exception may endanger the moral integrity of individual doctors who chose a career when abortion was illegal. The universal imposition of such a duty may result in repudiation of doctors as moral agents and damage trust in doctors that forms the basis of medical professionalism. Even if conscientious objection to abortion is granted as a legal right, most patients would experience no impediment to receiving abortion services because the healthcare environment of Korea provides options in which patients can choose their doctors based on prior information, there are many doctors who would be willing to provide an abortion, and Korea is a relatively small country. Finally, the responsibility to effectively balance and guarantee the respective rights of the two agents involved in abortion, the doctor and the patient, should be imposed on the government rather than individual doctors. This assertion is based on the government’s past behaviours, the nature of its relationship with doctors, and the capacity it has to satisfy both doctors’ right to conscientious objection and patients’ right to legal medical services. With regard to abortion services that will be sought in the near future, doctors should be granted the legal right to exercise conscientious objection based on the importance of doctor’s moral integrity, lack of impediment to patients, and government responsibility.

/pdf/conscientious-objection-to-abortion-why-it-should-be-a-1565oe109f.pdf

Conscientious objection to abortion: why it should be a specified legal right for doctors in South Korea.

This study suggests a model for continuing and comprehensive management of hypertension or Type 2 diabetes mellitus (T2DM) in Korea. Moreover, this paper computed the contribution cost of hypertension or T2DM management using the healthcare medical cost, which could have occurred from stroke, myocardial infarction (MI), and end-stage renal disease (ESRD) that were successfully prevented from the effective hypertension or T2DM management. Additionally, these costs were compared with the cost of implementing the hypertension or T2DM management model suggested in this study. This study used the medical fee summary of the health insurance claims submitted to National Health Insurance Corporation by medical facilities for services provided during the period from January 1st 1999 to December 31st 2006. The prevalence rate with treatment referred to cases in which patients submitted their medical claims at least once during the period, along with an accordant diagnosis. The incidence rate with treatment referred to cases in which patients who never submitted claims for the accordant disease during the five years from 1999 to 2003 submitted claims for the accordant disease in 2004 and 2005. The relative risk of the occurrence of stroke, MI and ESRD was 11.0, 13.6, and 30.3, respectively. The attributable risk of hypertension or T2DM for stroke was 0.730, and that for MI and ESRD were 0.773 and 0.888, respectively. Based on these, the contribution cost of hypertension or T2DM is estimated to be 986.3 billion Korean Won(KRW) for stroke patients, 330.5 billion KRW for MI patients, and 561.7 billion KRW for ESRD patients as in 2005. Hence, the total contribution cost of hypertension or T2DM to stroke, MI, and ESRD is 1.878 trillion KRW. The estimate for operational costs included an annual expenditure of 50,000 KRW per each recipient and an annual subsidy of 0.22 million KRW per person for the 1.6 million low.income individuals with hypertension or T2DM to cover their out.of.pocket medical expenses. Under this assumption, it took approximately 0.6 trillion KRW to manage 5 million high.risk patients in the low. and mid.income range, coverings up to 50% of costs. In conclusion, considering the potential benefits of preventing stroke, MI, and ESRD, the costs seems to be reasonable.

A National Chronic Disease Management Model and Evaluation of Validity of Primary Care Physician(PCP) Model in Korea

This study is to investigate the factors affecting the regional rate of certification for long-term care insurance benefits. Analyzed data were the 253,935 certified beneficiaries (equivalent to 4.9% of total elderly population) as long-term care degree (LTC degree) 1~3 extracted from the applicants for long-term care in the beginning stage of the system from April 15 2008 to July 1 2009. Although the data were collected from individuals, after restructured into regional data and then analysed in the unit of 225 administrative regions for the Korean Long-term Care Insurance. The rate of certification was operated as the percentage of people of LTC degree 1~3 to the elderly population in each region. The average rate of certification among regions was 4.91%, and ranged from 2.20% to 8.32%. In the analysing regression models, most socio-demographic variables, applicants` disease characteristics, regional service infrastructure, and the certification interviewer`s characteristics were included. The most influencing variables were the disease factors of applicants, especially dementia or cerebrovascular disease rather than arthritis, osteoporosis, or fracture patients were strong factors for the regional rate of certification. However, advanced studies adding more explainable factors on the regional variance of certification rate would be necessary to provide political agenda and measures for evidence-based certification process with high reliability and validity for a sustainable LTC system in Korea.

Factors affecting regional rate of certification in Korean Long-term Care Insurance

To vitalize the link program of Korean long-term care insurance system to community-based services for non-eligible people, we analysed the claim data from the Korean National Health Insurance Corporation (NHIC), and conducted a questionnaire survey to charging employees of elderly service department at local governments. The subjects were all 81,377 people, 57,454 of them were arranged to community-based services. The link program was more necessary among the missed subjects rather than the arranged people due to the need for physical or psychological assistance. By the result of the survey to the local government employees, 59.5% of subjects responded their proportion of link service was over 10% and under 20%, and 54.3% of them responded their job boundary are not clear. Major type of linking was notification the subject list to local government, 91.4%; proportion of periodical notification on the status of their service link were 57.1%, only 7.1% were followed to manage after the link. Difficult factors at the link process were pointed out the overload by other side work, deficiency of resources, rigidity of priority of link, and so on. Considering these results, to vitalize the community-based services to the non-eligible people, it may be essential the active participation of the subjects, construction of parts working in coordination among the institutions including NHIC, local governments, and service providers; development of various services for maintenance or promotion of the non-eligible peoples` health and functional status; and active participation of institutions from the third sector, and so on.

A study on the present status and improving management of the non-eligible people in Korean long-term care insurance system

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A National Chronic Disease Management Model and Evaluation of Validity of Primary Care Physician(PCP) Model in Korea

Factors affecting regional rate of certification in Korean Long-term Care Insurance

A study on the present status and improving management of the non-eligible people in Korean long-term care insurance system