Care In Korea Research Articles

Long-run measurement of income-related inequalities in health care under universal coverage: evidence from longitudinal analysis in Korea

BackgroundMany countries have sought to promote well-being for their entire populations through the implementation of universal health coverage (UHC). To identify the extent to which UHC has been attained, it is necessary to evaluate equity of access to use of needed care and the cost burden of health services for the country’s entire population. This study considers income-related inequalities in health care utilization and spending in a long-term perspective for the case of the Republic of Korea.MethodsExploiting longitudinal data from a nationally representative health survey from 2008 to 2018, this study investigates how income-related inequalities in health care in Korea have varied over time and examines the extent to which need and non-need factors contribute those inequalities, using an in‐depth decomposition analysis, allowing for heterogeneous responses across income groups.ResultsThe empirical results show that overall health care utilization is disproportionately concentrated among the poor over both the short and long run. Income-group differences and non-need determinants, such as marital status and private health insurance, make larger pro-poor contributions to inequality in inpatient care use, while chronic disease prevalence greatly pushes outpatient care utilization in a pro-poor direction. The results regarding inpatient care expenses indicate a similar pattern of pro-poor bias. Long-run inequality favors the better-off in terms of outpatient care expenses, where the contribution of income-group differences has the largest impact.ConclusionMy findings suggest that it is important for health care policy in Korea to focus on improvements in the health status and well-being of low-income groups, as poor people are likely to be in poorer health. Non-need contributors could worsen pro-poor inequalities if the economic disparity across households were to increase due to the demographic transition. Higher spending on inpatient care may be a heavier financial burden for low-income people. Additional supportive measures should be provided to prevent them from suffering economic hardship. By contrast, people in high-income groups may spend most on costly services in outpatient care, including uninsured services, with the help of private health insurance. Nevertheless, the expansion of income disparity should be alleviated even from a health care policy perspective.

Regular HbA1c examination and health outcomes in adult patients with type 2 diabetes in South Korea: A retrospective cohort study.

Concerns have been raised about the effectiveness of using process-centered indicators to assess the quality of diabetes care in Korea. This study aims to examine the factors influencing the performance of regular HbA1c testing and to explore its association with health outcomes, including hospitalization and mortality. We utilized a retrospective cohort design with a 4-year follow-up period, involving 159,452 adult patients newly diagnosed with type 2 diabetes (E11 in International Classification of Diseases, 10th Edition) in 2011. We established a national population database by merging the Korea National Health Insurance (KNHI) claims database and the KNHI Qualification Database of South Korea. The proportion of diabetic patients who underwent regular HbA1c testing at least once a year in the first 3 years was determined to be 33.8%. In comparison, patients who did not receive regular tests during the same period exhibited significantly increased odds of hospitalization (diabetes/CVD/renal, OR, 1.23, 95% CI, 1.12-1.34; diabetes, OR, 1.36, 95% CI, 1.17-1.57). Additionally, this nonpatient group experienced a higher risk of mortality (OR: 1.56, 95% CI: 1.36-1.80). This study supports the positive impact of regular HbA1c testing on health outcomes for individuals with type 2 diabetes. To increase the current 33% rate of regular HbA1c testing, developing patient-customized management policies is essential. Priority should be given to diabetic patients aged 65 or older, living in rural areas, and those belonging to low-income families (medical aid).

Enhancing the Evaluation System of Training Hospitals for Neurosurgical Residency Training and Education in South Korea : Striving for Balanced Participation and Differentiation.

The Korean Neurosurgical Society, with its 62 years of history, has witnessed substantial growth in the field of neurosurgery, producing over 3,400 neurosurgeons, establishing 12 divisions and 9 regional branches, and advancing in clinical management, diagnostic methods and academic research. Despite these developments, the regulations governing neurosurgical training and evaluation methods for training hospitals have remained largely unchanged, necessitating comprehensive revisions in response to evolving medical environments. To provide balanced participation opportunities for neurosurgery residents, the Korean Neurosurgical Society formed the Training Status Investigation Standard Change Task Force (TF Team) under the Training Education Committee. This paper presents the TF Team's findings and proposals for revising training status investigation standards and evaluation criteria. Through the processes including a lot of team meetings, workshops, education programs, official communications with 12 division societies, benchmarking from other societies and analysis of encrypted data from the past 5 years for neurosurgical training hospitals, the TF Team created a revised training status investigation proposal, supplemented main surgery criteria. And we applied this revised proposal to the training status investigation data collected from training hospitals in 2022 for simulation. We reduced the score for main surgeries to 10 points, introduced core competency surgery standards, allocating 5 points each for brain core competency surgery and spine and peripheral core competency surgery, for a total of 10 points. We also adjusted the major surgery score to 13 points, expanding the total surgery index score to 33 points. We introduced additional definitions for main surgeries in the areas of spine, pediatrics, and functional surgery. The equipment score was reduced from 17 points to 9 points. We specified minimum requirements for resident allocation eligibility, and if a hospital meets all of these criteria, they become eligible to apply for resident allocation. We introduced a new bonus point system for hospitals performing mechanical thrombectomy or stenting and peripheral nerve. The proposed revisions aim to improve the training and education of neurosurgical residents and overall neurosurgical care in Korea by creating a balanced and differentiated evaluation system for training hospitals. Further monitoring, communication, and adjustments are crucial for successful implementation.

Inpatient Hospice Care in Korea during the COVID-19 Pandemic: A Preliminary Study.

This study examined the quality of life (QoL) and quality of care (QoC) in inpatient hospice settings in Korea before and during the coronavirus disease 2019 (COVID-19) pandemic. Data were obtained from three institutions that participated in two prospective cohort studies. The primary outcomes measured were the QoL of patients with terminal cancer and their family caregivers (FCs), as well as the QoC as perceived by the FCs. Multivariable regression analysis revealed that during the COVID-19 pandemic, both patients and FCs experienced better QoL than before the pandemic, and FCs reported a higher QoC. Health policymakers should consider our findings when planning for future pandemics.

Trends in Regional Disparities in Cardiovascular Surgery and Mortality in Korea: A National Cross-sectional Study.

Regional disparities in cardiovascular care in Korea have led to uneven patient outcomes. Despite the growing need for and access to procedures, few studies have linked regional service availability to mortality rates. This study analyzed regional variation in the utilization of major cardiovascular procedures and their associations with short-term mortality to provide better evidence regarding the relationship between healthcare resource distribution and patient survival. A cross-sectional study was conducted using nationwide claims data for patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by the relevance index (RI). The associations between the regional RI and 30-day mortality were analyzed. The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p=0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex procedures. Disparities should be addressed through collaboration among hospitals and policy efforts to improve outcomes.

The Characteristics of Patients Using Home-Based Primary Care in Korea

The Characteristics of Patients Using Home-Based Primary Care in Korea

Network analysis of stroke systems of care in Korea

BackgroundThe landscape of stroke care has shifted from stand-alone hospitals to cooperative networks among hospitals. Despite the importance of these networks, limited information exists on their characteristics and functional attributes.MethodsWe...

Characteristics of Homebound and Patients with Disability Who Use Home-Based Primary Care in Korea: A Retrospective Study for 2018-2022.

(1) Background and Methods: This study evaluated characteristics of South Korean patients necessitating home-based primary care (HBPC) from 2018 to 2022, distinguishing between homebound individuals with chronic conditions and those with registered disabilities. (2) Result: Among 171 HBPC recipients, 56.1% were homebound, predominantly older with a median age of 81 years (interquartile range (IQR 68.5-86.0)), while 43.9% were disabled, generally younger with a median age of 39 years (IQR, 28-64). Activities of daily living were assessed, revealing a median score of 14 (IQR, 10-19), indicative of high care dependency. The most common conditions among homebound patients were dementia (27.1%) and physical mobility difficulties (21.9%), whereas mental disabilities (53.3%) and mobility issues (36.0%) prevailed in disabled patients. The primary HBPC needs for homebound patients included management of acute medical conditions (27.1%) and sores (17.7%). Conversely, regular health check-ups (46.7%) and management of neuropsychiatric symptoms (26.7%) were prevalent among the disabled group. (3) Conclusion: Notably, over 90% of HBPC patients required assistance with daily activities, highlighting significant differences in the needs and characteristics between older, homebound individuals with multiple comorbidities and younger, disabled patients receiving medical aid. These insights emphasize the necessity to develop customized HBPC programs to adequately cater to the diverse patient needs within South Korea.

For the Universal Right to Access Quality End-of-Life Care in Korea: Broadening Our Perspective After the 2018 Life-Sustaining Treatment Decisions Act.

For the Universal Right to Access Quality End-of-Life Care in Korea: Broadening Our Perspective After the 2018 Life-Sustaining Treatment Decisions Act.

Home medical care and Home health care system and roles of the public health care in Korea

In the face of rapid aging in Korea, the demand for appropriate medical services for the elderly at home is increasing. This study investigates the current status of home medical care and Home health care in Korea based on the concept of Home-based primary care, and proposes strategies to implement home-care in public health centers and public hospitals that play a major role in the field of public health care.First of all, by presenting a conceptual framework for the current status of Korea’s home medical care and Home health care provision system, and described according to three financial resources: National Health Insurance(NHI), Long-Term Care Insurance(LTCI), and public health care. At the current level, the home health care systems are fragmented and they should be redesigned to improve the home care services.In order to implement home care in public health care institutions, a model centered on public health centers and public hospitals is proposed. Public health centers have various advantages, responsibility positions, and access to information, but they have working conditions and difficulties in providing incentives, and medical and nursing limitations. Public hospitals can provide a variety of services, but community access and insufficient knowledge are pointed out as disadvantages. Therefore, it is important to establish a cooperative system between the two institutions.Finally, we proposes the division and cooperation between public health centers and private medical institutions according to the level of service. Private medical institutions could be in charge of active treatment, medical services and skilled nursing cares. public health centers could perform monitoring and follow-up the patients. it is necessary to establish a coordinating system to cooperate the two parts of institutions.

Perceptions regarding the multidisciplinary treatment of patients with severe trauma in Korea: a survey of trauma specialists.

Patients with multiple trauma necessitate assistance from a wide range of departments and professions for their successful reintegration into society. Historically, the primary focus of trauma treatment in Korea has been on reducing mortality rates. This study was conducted with the objective of evaluating the current state of multidisciplinary treatment for patients with severe trauma in Korea. Based on the insights of trauma specialists (i.e., medical professionals), we aim to suggest potential improvements. An online questionnaire was conducted among 871 surgical specialists who were members of the Korean Society of Traumatology. The questionnaire covered participant demographics, current multidisciplinary practices, perceived challenges in collaboration with rehabilitation, psychiatry, and anesthesiology departments, and the perceived necessity for multidisciplinary treatment. Out of the 41 hospitals with which participants were affiliated, only nine conducted multidisciplinary meetings or rounds with nonsurgical departments. The process of transferring patients to rehabilitation facilities was not widespread, and delays in these transfers were frequently observed. Financial constraints were identified by the respondents as a significant barrier to multidisciplinary collaboration. Despite these hurdles, the majority of respondents acknowledged the importance of multidisciplinary treatment, especially in relation to rehabilitation, psychiatry, and anesthesiology involvement. This survey showed that medical staff specializing in trauma care perceive several issues stemming from the absence of a multidisciplinary system for patient-centered care in Korea. There is a need to develop an effective multidisciplinary treatment system to facilitate the recovery of trauma patients.

Awareness of the concept and role of public oral health care in Korea among oral health professionals

Awareness of the concept and role of public oral health care in Korea among oral health professionals

PERSON-CENTERED DEMENTIA CARE IN SOUTH KOREA: AN INTEGRATIVE REVIEW

Abstract Person-centered dementia care is a globally recognized best practice; however research on this practice is lacking. In Korea, the number of people living with dementia is rapidly increasing, expanding the need for person-centered care. Thus, we reviewed published studies regarding person-centered dementia care in Korea. We searched for studies in four databases (RISS, KISS, KoreaMED, and DBpia) and selected 14 primary studies published between 2007 and 2023. Two reviewers extracted data and three reviewers analyzed the data. Search keywords included person-centered care, person-centred care, person-centered dementia care, person-centred dementia care, dementia, demented, Alzheimer, or cognitive impairment. A total of 14 articles met inclusion criteria. The primary studies were published between 2007 and 2023, and most studies were conducted in long-term care settings and targeted formal care staff. The authors’ disciplines included nursing, social welfare, humanity, and human services. Many studies did not report theory or theoretical models. Research designs included non-experimental study (8), qualitative study (4), and experimental study (2), and randomized clinical trial (1). Many studies did not report on theory or theoretical models. Most quantitative studies included variables such as personhood in dementia, person-directed care, person-centered climate, dementia knowledge, or attitude toward dementia. Most quantitative studies reported that person-centered dementia care education programs enhanced personhood in dementia in long-term care settings. The qualitative studies explored the meaning of humanitude, readiness to adapt, effective communication, or education programs related to person-centered dementia care. Future scholars should conduct experimental studies or mixed-method studies to report on theory or theoretical models.

How should the healthcare system support cancer survivors? Survivors’ and health professionals’ expectations and perception on comprehensive cancer survivorship care in Korea: a qualitative study

BackgroundQualitative research on cancer survivors’ need for comprehensive cancer survivorship care within the health care system is limited. Our study aimed to understand cancer survivors' and health professionals' expectations and perceptions for developing a comprehensive cancer survivorship care system in South Korea.MethodsAn exploratory qualitative study was conducted. A total of 16 subjects (11 cancer survivors and 5 health professionals) were purposively sampled from Regional Cancer Survivorship Centers or Cancer Survivor Clinics in Korea. In-depth semi-structured online or face-to-face interviews were conducted. Six steps of thematic analysis were used to analyze data.ResultsThe following four primary themes emerged from the interviews: 1) introducing a customized follow-up care system to improve continuity of survivorship care, 2) implementing educational strategies for both survivors and health professionals to manage changed health, and 3) accepting cancer survivors as companions. These three themes included a total of nine subthemes. As a result, the comprehensive survivorship model identified needs in terms of 1) changes in the medical healthcare system and core services that can accommodate the cancer survivors’ condition and 2) necessary care services and social support for cancer survivors.ConclusionsThis study identified the existing gaps in Korea’s current healthcare system regarding comprehensive cancer survivorship care for cancer survivors. Further research on eHealth-based counseling and educational support, the payment models of cancer survivorship care within universal health coverage, and changing social perceptions to strengthen the biopsychosocial needs of cancer survivors is needed.

Current Status of Korean Low-vision Care According to a Survey of Korean Ophthalmological Society Members

Purpose: To investigate the status of low-vision care in Korea and the needs of ophthalmologists, and to define future directions for the diagnosis and treatment of low-vision patients.Methods: Twenty survey questions exploring low-vision knowledge were emailed to members of the Korean Ophthalmological Society, and the responses were analyzed.Results: In total, 158 responses were collected from ophthalmologists working in different institutions, including 62 (45.6%) at university hospitals. Many respondents (91, 57.6%) reported knowing the criteria for low vision, but approximately half (74, 46.9%) reported that they had little or no knowledge of low vision in general. More than half of the respondents (87, 55.1%) had never written a prescription for a visual aid, and only 32 (20.2%) were able to prescribe such aids. The principal reasons for hesitation in the treatment of low-vision patients were lack of knowledge (117, 74.5%) and poor medical reimbursement (41, 26.1%). Many respondents (152, 96.2%) wanted to learn more about low vision, and approximately half (71, 45.5%; 74, 47.4%) felt that the current low-vision care environment in Korea requires improvement.Conclusions: Despite the increasing need for low-vision care in South Korea, the number of ophthalmologists who can provide such care (including prescriptions for visual aids) is insufficient. Lack of education and poor medical reimbursement are important problems. Low-vision clinics must promote outreach activities, and institutions should develop programs to educate ophthalmologists.

Changes in the Place of Death of Patients With Cancer After the Introduction of Insurance-Covered, Home-Based Hospice Care in Korea

Although hospice care has been covered by health insurance for the purpose of improving the quality of life of patients with terminal cancer as well as their caregivers, few studies have evaluated the outcomes of the policy to cover home-based hospice care services. To investigate the changes in the place of death of patients with cancer after the introduction of insurance-covered, home-based hospice care services in Korea. This cohort study used data from February 1, 2018, to December 31, 2021, from the Causes of Death Statistics database, released annually by Statistics Korea, which contains information on all deaths in the country. Individuals who died of cancer, a representative hospice-eligible disease, were assigned to the case group, and those who died of dementia, a non-hospice-eligible disease, were assigned to the control group. A total of 218 522 individuals constituted the study population. Because the Korean Health Insurance Service had begun covering home-based hospice care services on September 1, 2020, and the last follow-up date was December 31, 2021, the follow-up periods for before and after intervention were 31 months and 16 months, respectively (preintervention period: February 1, 2018, to August 31, 2020; postintervention period: September 1, 2020 to December 31, 2021). The place of death was categorized as a binary variable according to whether it was the person's own home or not. Comparative interrupted time-series models with segmented regression were applied to analyze the time trend and its change in outcomes. Of the 218 522 deaths eligible for the analysis (mean [SD] age at death, 78.6 [8.8] years; 130 435 men [59.7%]), 207 459 were due to cancer, and 11 063 were due to dementia. Immediately after the introduction of home-based hospice care, the rate of home deaths was 24.5% higher for patients with cancer than for those with dementia (estimate, 1.245 [95% CI, 1.030-1.504]; P = .02). The difference in the level change between cancer deaths and dementia deaths, on intervention, was more pronounced for those living in rural areas (estimate, 1.320 [95% CI, 1.118-1.558]; P = .001). In addition, a higher educational level was associated with a larger difference in the immediate effect size due to home-based hospice care (low educational level: estimate, 1.205 [95% CI, 1.025-1.416]; P = .02; middle educational level: estimate, 1.307 [95% CI, 0.987-1.730], P = .06; high educational level: estimate, 1.716 [95% CI, 0.932-3.159]; P = .08). In this cohort study exploring the changes in the place of death for patients with cancer after the insurance mandates for home-based hospice care in Korea, the probability of patients with cancer dying in their own homes increased after the intervention. This finding suggests the need to broaden the extent of home-based hospice care to honor the autonomy of individuals with terminal illness and improve their quality of death.

What to learn from analysis of medical disputes related to medication errors in nursing care.

Nurses, who are the last safeguard against and have the final opportunity to prevent medication errors (MEs), play a vital role in patient safety by managing medications. This study described the characteristics of medical dispute cases, medication information, and stage and types of MEs in Korea. We performed a descriptive analysis of 27 medical dispute cases related to MEs in nursing care in Korea. Around 77.7% of patients suffered serious harm or died due to MEs in this study. The types of medications included anxiolytics and analgesics, and 51.9% of them were high-alert medications. Among cases of administration errors, failure to patient assessment before and after administration was the most common error followed by administering the wrong dose. Nurses should perform their duties to ensure safety and improve the quality of nursing care by monitoring patients after administering medications and should be prepared to take quick action to reduce harm.

Investigation of the abortion-related experience of the providers, women, and advocators in South Korea: The neglected essential healthcare service.

The decriminalization of abortions in South Korea in 2019 has not been followed by the establishment of policies ensuring access to abortion services. This study aimed to explore the current challenges and barriers for quality abortion services in the Korean healthcare system. Eleven women, six healthcare providers, and 11 advocates participated in in-depth interviews in 2020. Experiences of abortion were analyzed using the modified Availability, Accessibility, Acceptability, and Quality (AAAQ)framework. While informal, access to surgical abortion services was possible in general. However, accessibility to services and information varied according to women's age, marital status, and physical condition. Considering that the Korean government has been reluctant to adopt proactive measures to ensure access to abortion services, the quality of abortion care in Korea remains questionable, with the mandate of male consent for abortion prevailing. The women interviewed in this study expressed dissatisfaction with their current access to and the quality of abortion services. Abortion is an essential service that ensures the sexual and reproductive health and rights of women. Although abortion was decriminalized in Korea in 2019, it remains an informal and stigmatized service. Further research and policy efforts are required to ensure access to abortion in Korea.

Psychometric properties of the Korean version of the oncofertility barriers scales among nurses: A methodological study

ObjectiveThis study aimed to examine the psychometric properties of the Korean version of the Oncofertility Barrier Scale (K-OBS). MethodsThis methodological study investigated the validity and reliability of the K-OBS for measuring barriers to oncofertility care among nurses. A total of 270 nurses who had experience in rendering nursing care to cancer survivors were recruited, and the instrument was translated, assessed for content validity, and tested using a preliminary survey. Construct validity was established through explanatory factor analysis. Convergent validity and discriminant validity were analyzed using a multitrait-multimethod (MTMM) matrix. Reliability was assessed using Cronbach's alpha and McDonald's omega. ResultsThe K-OBS demonstrated satisfactory validity and reliability, with seven factors, including 27 items explaining 60.42% of the total variance, a Cronbach's alpha of 0.86, and a McDonald's omega of 0.83. The seven factors were labeled, “Lack of information and education” (8 items), “Rigid thinking toward oncofertility care” (5 items), “Cancer patient stereotypes” (4 items), “Insufficient support” (4 items), “Desire for fertility preservation” (2 items), “Interrupted oncofertility care” (2 items), and “Fertility risk” (2 items). ConclusionsThe results of this study indicate that the K-OBS may be a suitable instrument with acceptable validity and reliability for evaluating barriers to oncofertility among Korean nurses. This instrument can be used to identify obstacles that make oncofertility care difficult, thereby contributing to new insights for improving the future quality of oncofertility care in Korea.

Impact of institutional case volume on intensive care unit mortality.

The primary aim of this review is to explore current knowledge on the relationship between institutional intensive care unit (ICU) patient volume and patient outcomes. Studies indicate that a higher institutional ICU patient volume is positively correlated with patient survival. Although the exact mechanism underlying this association remains unclear, several studies have proposed that the cumulative experience of physicians and selective referral between institutions may play a role. The overall ICU mortality rate in Korea is relatively high compared to other developed countries. A distinctive aspect of critical care in Korea is the existence of significant disparities in the quality of care and services provided across regions and hospitals. Addressing these disparities and optimizing the management of critically ill patients necessitates thoroughly trained intensivists who are well-versed in the latest clinical practice guidelines. A fully functioning unit with adequate patient throughput is also essential for maintaining consistent and reliable quality of patient care. However, the positive impact of ICU volume on mortality outcomes is also linked to complex organizational factors, such as multidisciplinary rounds, nurse staffing and education, the presence of a clinical pharmacist, care protocols for weaning and sedation, and a culture of teamwork and communication. Despite some inconsistencies in the association between ICU patient volume and patient outcomes, which are thought to arise from differences in healthcare systems, ICU case volume significantly affects patient outcomes and should be taken into account when formulating related healthcare policies.