Korean Healthcare Research Articles

Safety of resuming biologic DMARDs in patients who develop tuberculosis after anti-TNF treatment

To estimate the incidence of tuberculosis (TB) in rheumatoid arthritis (RA) patients treated with tumor necrotizing factor inhibitor (TNFI) and evaluate the safety of resuming biologic disease-modifying anti-rheumatic drugs (DMARDs) in patients who developed TB after anti-TNF treatment. We conducted an inception cohort study of RA patients in the Korean Healthcare Claims Database who started TNFI as the first biologic DMARD between January 2009 and December 2013. The incidence rate (IR) of TB was estimated among total TNFI starters and a nested case-control analysis was performed to compare the characteristics of patients who developed TB and those did not. Patients diagnosed with relapsed TB after resuming biologic DMARDs were identified and their features were described. We included 4638 RA patients who started TNFI, contributing 8542 PYs of follow-up. The IR of TB in TNFI users was 1.10 (CI: 0.86-1.34) per 100 PYs. After the initial 6 months, the IR was highest at 1.56 (CI: 1.02-2.10) and decreased gradually over time. Among the 81 patients who developed TB, 30 patients (37.0%) resumed biologic DMARDs with a mean interval of 3.3 months after TB development. Two cases of TB were detected among 30 patients with an observational period of 45.7 PY. The IR of TB in RA patients who started TNFI was 1.10 per 100 PYs. This rate was highest during the first 6 months. Resumption of biologic DMARDs requires careful monitoring for TB relapse.

The Obesity Paradox in Colorectal Cancer Surgery: An Analysis of Korean Healthcare Big Data, 2012–2013

ABSTRACTAlthough it is well known that obesity increases the risk of colorectal cancer, several studies have recently suggested that those who are overweight or class-one obese have better outcomes after surgery. However, the impact of obesity on the success of colorectal cancer surgery remains controversial. The medical records of patients diagnosed with colorectal cancer who were treated surgically from 2012 through 2013 were retrospectively analyzed. Data from a total of 36,740 patients were provided by the Healthcare Big Data Hub of the Korean Health Insurance Review & Assessment Service. Multivariate analyses suggested that hospital length of stay (LOS) was significantly associated with age, cancer stage, and body mass index. The odds ratios of spending more than 2 weeks in the hospital for the overweight or class-one obese groups compared to the normal weight group were 0.903 (95% confidence interval, 0.866–0.941) and 0.887 (95% confidence interval, 0.851–0.924), respectively, while that of the underweight group was 1.280 (95% confidence interval, 1.202–1.362). The “obesity paradox” applies to colorectal cancer, as indicated by decreased hospital LOS of overweight and obese patients. This result suggests that there is a protective effect of nutritional status in obese patients, which contributes to recovery from colorectal cancer surgery.

Korean Translation of the Barriers to Research Utilization Scale: Psychometric Testing.

The purpose of this study was to assess the psychometric properties of the Barriers or Facilitators to Using Research in Practice (BARRIERS) scale for use in Korea. A cross-sectional study design was used with 364 nurses working in clinical settings. Item analysis was conducted and convergent and discriminant validity were evaluated using confirmatory factor analysis. Internal consistency reliability was evaluated using Cronbach's alpha coefficients. Confirmatory factor analysis revealed a 4-factor structure with 25 items that explained 62.9% of the variance. Convergent and discriminant validity were confirmed as examining the factor loading, average variance extracted, and composite reliability. The values of factor loading for 25 items were having higher estimate than criterion and the average variance extracted value for 4 factors ranged from .575 to .667. The Cronbach's alpha was .90 for the 25 items. The Korean version of the 25-item BARRIERS scale was a reliable and valid scale to measure barriers to research use in Korean health care settings. Based on this psychometric evaluation, research barriers and its associated factors will be investigated using the Korean version of the BARRIERS scale in further study.

OP64 Economic Impact Of Cardiac Device Remote Monitoring In South Korea

INTRODUCTION:The reduction of healthcare costs and societal cost due to remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been demonstrated in several countries; however, to the best of our knowledge it does not exist for South Korea. This work aims at providing an estimation of the potential benefit of RM versus standard care (SC) of CIEDs in term of healthcare costs in South Korea, in order to provide additional substance to the currently ongoing societal debate about the value of telemedicine.METHODS:Healthcare resource consumption was taken from the results of the TARIFF study, a prospective, non-randomized, multicenter clinical trial designed in Italy to assess the economic benefits of RM follow-up in comparison with standard follow-up in 209 patients (107 SC, 102 RM). The main results demonstrated that RM reduced healthcare resource consumption by 54 percent from a healthcare services perspective (SC: EUR1,044.89±1,990.47 versus RM: EUR482.87±2488.10, p<.0001 (1).In order to perform a cost analysis from the perspective of the South Korean healthcare payer, the following unit costs were assigned to resources collected in TARIFF (hospitalizations, visits, examinations): fee-for-service tariffs, emergency tariffs and outpatient tariffs. Remote follow-up costs were considered as zero.RESULTS:From the perspective of the South Korean healthcare payer, the overall mean annual cost/patient in the RM group is 53 percent lower than in SC group (SC: EUR405,439±40,135 versus RM: EUR189,96±725,52, p<.0001) (SC: KRW 497,145±49,2137 versus RM: KRW 232,936±890,181, p<.0001). This is mainly due to a significant cost reduction in device-related hospitalizations, examination tests and visits in the follow-up period.CONCLUSIONS:RM of CIED patients is cost-saving from the perspective of the South Korean healthcare system. Introducing appropriate reimbursement for remote monitoring of CIED is not likely to change this result and should make RM sustainable for the provider and encourage widespread adoption of RM.

2016 Year-in-Review of Clinical and Consumer Informatics: Analysis and Visualization of Keywords and Topics.

ObjectivesThe objective of this study was to review and visualize the medical informatics field over the previous 12 months according to the frequencies of keywords and topics in papers published in the top four journals in the field and in Healthcare Informatics Research (HIR), an official journal of the Korean Society of Medical Informatics.MethodsA six-person team conducted an extensive review of the literature on clinical and consumer informatics. The literature was searched using keywords employed in the American Medical Informatics Association year-in-review process and organized into 14 topics used in that process. Data were analyzed using word clouds, social network analysis, and association rules.ResultsThe literature search yielded 370 references and 1,123 unique keywords. ‘Electronic Health Record’ (EHR) (78.6%) was the most frequently appearing keyword in the articles published in the five studied journals, followed by ‘telemedicine’ (2.1%). EHR (37.6%) was also the most frequently studied topic area, followed by clinical informatics (12.0%). However, ‘telemedicine’ (17.0%) was the most frequently appearing keyword in articles published in HIR, followed by ‘telecommunications’ (4.5%). Telemedicine (47.1%) was the most frequently studied topic area, followed by EHR (14.7%).ConclusionsThe study findings reflect the Korean government's efforts to introduce telemedicine into the Korean healthcare system and reactions to this from the stakeholders associated with telemedicine.

예비의료인의 통일보건의료에 대한 인식

Purpose: The purpose of this study was to investigate the awareness of Korean unification and health care in healthcare professional students. Methods: Descriptive survey design was used, and self administered questionnaires were collected from 567 participants. The data were analyzed using descriptive statistics, chi-square test, ANOVA, and scheffe test. Results: A total of 279(54.4%) students answered that Korean unification is needed. The mean score of attentiveness to Korean unification was 5.27(<TEX>${\pm}2.10$</TEX>) out of 10, and the mean score of interest on health care for unification was 4.28(<TEX>${\pm}2.26$</TEX>). The degree of interest in Korean unification was significantly associated with the degree of health care for unification(p<.001). The mean score of necessity regarding health care education for unification was 5.59(<TEX>${\pm}2.15$</TEX>) out of 10, which was proportional to the degree of interest in the Korean unification(p<.001). The mean score of knowledge regarding North Korea's medical status was 2.35(<TEX>${\pm}1.17$</TEX>) out of 10. Conclusion: Based on the study results, continuous education about unification as well as health care for unification is required in order to increase awareness of Korean unification and healthcare in students. Furthermore, additional studies to better understand nursing care systems of North Korea and to identify the roles of nurses in the unification process and public healthcare of unified Korea are needed.

Patent, R&D and internationalization for Korean healthcare industry

Using panel data, this study investigates how Patent and R&D expenditures affect internationalization in Korean healthcare industry. Korean healthcare industry is designated as one of the core bread and butter industries. Tremendous government investments in Korean healthcare industry are expected to increase Patent and R&D expenditures, causing internationalization for Korean healthcare industry. In material way, this study focuses on testing spillover effects between Patent and R&D expenditures on internationalization.Empirical analysis is done by the panel GLS estimation using 47 Korean healthcare firms' 7 years' panel data. As empirical results, we find internationalization of Korea healthcare industry is positively affected by Patent and R&D expenditures but their impacts are limited. In addition, we find there is a non-linear relation between Patent and R&D expenditures on internationalization measured by exports so that spillover effects are significantly confirmed.We propose several suggestions that government lead R&D policy does not effectively increase internationalization, and spillover effects of Patent and R&D expenditures differently affect internationalization following internationalization phase. Practically, government lead R&D investments should be disseminated to private sector to vitalize internationalization of Korean healthcare industry.

A qualitative study of healthcare providers' perceptions and suggestions for developing cancer survivorship care models in South Korea.

This study aimed to explore healthcare providers' perceptions of the issues and problems as well as suggestions regarding the development of cancer survivorship care models in South Korea. An exploratory, descriptive, qualitative study was conducted with eight Korean healthcare providers using individual interviews. Purposive sampling was performed in a university hospital in Gyeonggi-do, Korea. Three concepts of the Chronic Care Model (CCM) were employed to identify the issues and problems with developing a survivorship care model for Korean cancer survivors. Based on these concepts, seven themes were identified: (1) absence of a multidisciplinary care system; (2) fragmented care services; (3) lack of emotional support; (4) absence of a shared care system for long-term survivorship care; (5) lack of communication between physicians and cancer survivors; (6) limited resources in the communities; and (7) poorly tailored long-term survivorship cancer care. In terms of suggestions, four themes were identified: (1) healthcare organisation; (2) clinical information systems; (3) community resources; and (4) follow-up care. The current study identified the applicability of key concepts from the CCM to formulate a Korean cancer survivorship model. Findings suggest that cancer survivors should be managed as persons with chronic diseases based on long-term survivorship care.

PRS10 - Hospital Resource Utlization of Patients Over 40 Years old with Chronic Obstructive Pulmonary Disease in South Korea

Chronic obstructive pulmonary disease is a leading cause of morbidity and associated healthcare resource utilisation globally and its burden is expected to increase in the rapidly aging nation of South Korea. The aim of this study is to investigate the burden of health care resource utilisation by COPD patients in S.Korea and the associated direct medical costs. This was a retrospective observational study of data from the National Patient Sample (NPS) data from the Health Insurance Review and Assessment Service (HIRA) for the year 2014. COPD Patients over 40 years of age were identified by searching on ICD-10 codes as well as usage of and COPD medication and/or systemic steroid usage within a hospital setting. Resource use for COPD was measured by number and length of hospital stays, number of emergency room and out-patient visits and the associated costs were assessed. Linear regression modelling is used to explore the impact of comorbidities on total health-care costs, adjusting for age, sex and geographic location. The number of COPD patients in Korea was estimated as 174,331 in this study and is comparable to what was previously reported. 71% of the identified COPD patients were male and the mean age of the subjects was 71 years indicating that COPD is potentially underdiagnosed in Korea. The average annual out-patient visits and average days of hospitalization for a COPD patient were estimated to be 44 and 33 days respectively. COPD adds an additional 573 million USD to direct medical costs for the Korean health care system. In the next stage of our analysis, we will stratify the costs per co-morbidities and other risk factors. In conclusion, this study demonstrated that high resource use and costs were associated with COPD. This is an important first step to enhance health care spending efficiency.

Equity in the utilization of physician and inpatient hospital services: evidence from Korean health panel survey.

BackgroundLittle is known regarding equity in health care utilization among Koreans since 2008. This study examines the extent to which equity in the use of health care services has been achieved in Korea.MethodsDescriptive and logistic regression analysis was performed. The sample for this study was 17,035 individuals who participated in interviews.ResultsDifferences in need substantially account for the original differences observed between subgroups of Koreans. Need factors were important determinants of Koreans using physician and inpatient hospital services. Having income did not ameliorate the subgroup differences in the use of physician services. Nonetheless, having income remains an important predictor of physician utilization.ConclusionsThe Korean health care system does not yield a fully equitable distribution of physician and inpatient hospital services. Health care reforms in Korea should continue to concentrate on insuring effective universal health care, implying that all population groups with need receive effective coverage.

Economic evaluation of eribulin as second-line treatment for metastatic breast cancer in South Korea.

BackgroundMetastatic breast cancer (MBC) is associated with poor prognosis, particularly for those patients with human epidermal growth factor receptor (HER2)-negative tumor. Similar to the rest of the world, treatment options are limited in South Korea following first-line chemotherapy with anthracyclines and/or taxanes. This study examined the cost-effectiveness and cost-utility of eribulin in South Korean patients with HER2-negative MBC who have progressed after usage of at least one chemotherapeutic regimen for advanced disease (second-line therapy).MethodsA partition survival model was developed from the perspective of the South Korean health care system. The economic impact of introducing eribulin as second-line therapy for HER2-negative MBC was compared to that of capecitabine and vinorelbine. The analysis estimated incremental cost per life-year (LY), that is, cost-effectiveness, and cost per quality-adjusted life-year (QALY), that is, cost-utility, of eribulin for management of HER2-negative MBC in South Korea. The model accounted for overall survival, progression-free survival, drug costs, grade 3/4 adverse events, and health care utilization. Deterministic and probabilistic sensitivity analyses were performed to identify uncertainty in the results of the economic evaluation.ResultsSecond-line eribulin was associated with greater benefits in terms of LY and QALY, compared to capecitabine and vinorelbine. The incremental cost-effectiveness ratio was ₩10.5M (approximately USD 9,200) per LY, and the incremental cost-utility ratio was ₩17M (approximately USD 14,800) per QALY in the basecase analysis. The incremental cost-utility ratio ranged from ₩12M (USD 10,461) to ₩27M (USD 23,538) per QALY in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, >99% of the simulations were below ₩50M (USD 42,300), and the lower and upper 95% confidence intervals were ₩3M (USD 2,600) and ₩24M (USD 20,900) per QALY, respectively.ConclusionThere currently exist a limited number of treatment choices for women with HER2-negative MBC. Eribulin is a cost-effective option for second-line therapy in South Korea and should be added to the current indications for reimbursement.

Economic Evaluation of Companion Diagnostic Testing for EGFR Mutations and First-Line Targeted Therapy in Advanced Non-Small Cell Lung Cancer Patients in South Korea.

BackgroundAs targeted therapy becomes increasingly important, diagnostic techniques for identifying targeted biomarkers have also become an emerging issue. The study aims to evaluate the cost-effectiveness of treating patients as guided by epidermal growth factor receptor (EGFR) mutation status compared with a no-testing strategy that is the current clinical practice in South Korea.MethodsA cost-utility analysis was conducted to compare an EGFR mutation testing strategy with a no-testing strategy from the Korean healthcare payer’s perspective. The study population consisted of patients with stage 3b and 4 lung adenocarcinoma. A decision tree model was employed to select the appropriate treatment regimen according to the results of EGFR mutation testing and a Markov model was constructed to simulate disease progression of advanced non-small cell lung cancer. The length of a Markov cycle was one month, and the time horizon was five years (60 cycles).ResultsIn the base case analysis, the testing strategy was a dominant option. Quality-adjusted life-years gained (QALYs) were 0.556 and 0.635, and total costs were $23,952 USD and $23,334 USD in the no-testing and testing strategy respectively. The sensitivity analyses showed overall robust results. The incremental cost-effectiveness ratios (ICERs) increased when the number of patients to be treated with erlotinib increased, due to the high cost of erlotinib.ConclusionTreating advanced adenocarcinoma based on EGFR mutation status has beneficial effects and saves the cost compared to no testing strategy in South Korea. However, the cost-effectiveness of EGFR mutation testing was heavily affected by the cost-effectiveness of the targeted therapy.

한방분야 적정성 평가 대상 질환 선정을 위한 전문가 Delphi 조사

Objectives As awareness of the public about Korean medicine health care and the social demand about improvement for quality of health care service is constantly rising, the quality evaluation of Korean medicine health care service is needed to improve the quality. Through trial of Delphi method, we tried to set the priority in short, medium, long term among the disease which is the subject of quality assessment. Methods Carrying out the delphi survey to 50 experts of korean medicine who were recommended by the 41 member societies of Korean medicine and related organizations, we selected final candidates for quality assessment. It is composed with total 2 rounds, and we investigated the priority in three aspects; the importance of the matter, possibility quality assessment, potential about if there`s any chance of improvement. Results By delphi method, we set the priority of quality assessment. Base on the result of the second round, we classified importance of the questions into above average, average, below average, and categorized items as short, medium, long term according on the final priority. We classified of musculoskeletal diseases and diseases of connective tissues and musculoskeletal injury as short term and cerebrovascular disease and disease of nerve system and malignant neoplasm as medium term, disease of digestive organs and diseases, symptoms and abnormal findings in clinical field or inspections which are not categorized as long term. Conclusions We set the subjects of quality assessment by delphi survey by experts, and classified into short, medium, long term. Further research is necessary for execution the Quality Assessment to each of the candidate. Also, we can send feedback to medical institution base on the result of Quality Assessment. then it would be able to induce the improvement in quality of medical institution by itself.

병원 전문화가 건당 재원일수와 건당 의료비에 미치는 영향

Background: Over the last few decades, because hospitals in South Korea also have undergone dramatic changes, Korean hospitals traditionally have provided specialized health care services in the health care market. Inner Herfindahl-Hirschman Index (IHI) measures hospital caseloads based on patient proportions, independent of patient volumes. However, IHI that rely solely on patient proportions might be problematic for larger hospitals that provide a high number of diagnosis categories, as the patient proportions in each category are naturally relatively smaller in such hospitals. Therefore, recently developed novel measure, category medical specialization (CMS) is based on patient volumes as well as patient proportions. Methods: We examine the distribution of hospital specialization score by hospital size and investigate association between each hospital specialization and length of stay per case and hospital cost per case using Korean National Health Insurance Service-cohort sample data from 2002 to 2013. Results: Our results show that IHI show a decreasing trend according to the number of beds and hospital type but CMS show an increasing trend according to the number of beds and hospital type. Further, inpatients admitted at hospitals with higher IHI and CMS had a shorter length of stay per case (IHI: B=-0.104, p<0.0001; CMS: B=-0.044, p=0.001) and inpatients admitted at hospitals with higher IHI and CMS had a shorter hospital cost per case (IHI: B=-0.110, p=0.002; CMS: B=-0.118, p=<0.0001). Conclusion: This study may help hospital policymakers and hospital administrators to understand the effects of hospital specialization strategy on hospital performance under recent changes in the Korean health care environment.

Utilization Patterns of Korean Medicine: An Analysis of the National Health Insurance Cohort Database from 2002 to 2013.

Although Korean Medicine (KM) is an important part of the Korean healthcare system and plays a significant role in chronic and incurable diseases, there is insufficient information about KM utilization. The aim of the study was to identify KM utilization patterns using a national representative sample data. KM users aged 0-80 years and older from the nationally representative sample in the National Health Insurance Service-National Sample Cohort of 778,506 KM users between 2002 and 2013 (were analyzed. Annual changes in utilization patterns were analyzed by sex, nine age groups, five income levels, and numbers of visits and hospitalizations. Utilization patterns by the type of healthcare institution and the top 10 major diseases were studied. Frequencies of KM use differed according to analyses of patients and claims. Women used KM 1.5 times more than did men. Patients in their 40s and 50s made up one third of KM users. In contrast to other studies, high-income groups used KM more than did low-income groups. More than 96% of ambulatory patients used mostly KM clinics, and more than 76% of inpatients used KM hospitals. Musculoskeletal disorders were the main disease treated, which conformed to the results of previous studies. The results suggest that women, people in their 40s and 50s, and people with a relatively high income use KM more often than other patients. Further comparison studies of both Western medicine in Korea and other countries should be conducted.

Health System Development and Performance in Korea and Japan: A Comparative Study of 2000-2013.

BackgroundThe Japanese and Korean healthcare systems are very similar and thus, they have the same problems and weaknesses. This study discusses the problems and proposes complementary solutions based on the results of a comparative analysis of conditions in the healthcare systems of the two countries.MethodsThis article presents a comparative analysis of the healthcare status of the two countries based on certain health criteria used worldwide, a literature review, and data from the Korean Ministry of Health and Welfare, Japanese Ministry of Health, Labour and Welfare, World Health Organization (WHO), World Bank, and Organization for Economic Cooperation and Development (OECD).ResultsThe scores of the healthcare systems were calculated for quantitative comparison. The performance of the Japanese health system was the best, followed by the Korean health system. Both countries observed an increased life expectancy and decreased infant and under-five mortality rates during the last 14 years. However, lower fertility rates were found, which could lead to a decreased working population and a subsequent increase in the economic burden of governments and households. A higher alcohol consumption rate was found in Korea, which was related to the establishment of interpersonal relationships.ConclusionThe reform of the healthcare systems in Korea and Japan led to an increased life expectancy; concurrently, reduced fertility rates led to an increasing aging population. As a result, increasing health costs require additional measures to improve health equity and strengthen health promotion.

A descriptive study of Korean nurses' perception of pain and skin tearing at dressing change.

This study aimed to investigate Korean nurses' level of awareness of pain and skin tearing in wound bed and/or peri-wound skin at dressing change. A descriptive study was performed. Convenience sampling was employed and registered nurses were recruited from attendees of continuing education program. A total of 399 participants (RN) completed questionnaire. Data was collected from September to November 2014. Many of them perceived skin tearing and wound related pain associated with dressing changing, but most of them did not assess and record pain and skin tearing at dressing change. More than half of respondents reported that they did not provide nursing intervention to prevent pain and skin tearing. Many of them reported that a systematic educational program for preventing pain and skin tearing at dressing change was needed. In conclusion, many of respondents were aware of pain and skin tearing at dressing change, but did not take any further necessary measures, including nursing intervention, for the most appropriate, systematic pain and skin tearing management. Therefore, this study suggested that a systematic and comprehensive educational program for Korean healthcare professions needs to be developed and implemented in Korea's hospital settings.

Korean Immigrants Health and Healthcare Practices in Rural America: A Systematic Review

Purpose: A systematic review of the literature was conducted to determine Korean Immigrants’ health and healthcare practices. Method: A systematic review of relevant studies was conducted between 2005 and 2013 using CINAHL Complete and Science Direct within the EBSCOhost Discovery Service and the Cochran Library as outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Original research articles discussing the health and healthcare among Korean immigrants in the United States were reviewed. Key terms included Korean immigrants, rural, Texas, healthcare, research, and Koreans. Findings: Using various combinations of the key terms, the search produced 243 potential relevant records with only 25 being eligible for review. No studies represented rural regions. Furthermore, only one study was conducted in Texas. Twenty-five records described the state of health and healthcare among Korean immigrants. Topics included socialization, healthcare utilization, cancer screening practices, a prevalence of depression, knowledge of hypertension and stroke, and level of physical activity. Conclusions: Despite the review, Korean immigrant’s health and healthcare are still largely unknown, especially when taking rurality into context. Health disparities are more likely to occur in rural medically underserved areas than in urban areas. The presence of such health disparities is even more probable among Korean immigrants. An increased knowledge of the Korean culture is needed among healthcare practitioners to promote health and healthcare among these vulnerable populations. Keywords: Korean, Texas, Rural, Health, Healthcare DOI: http://dx.doi.org/10.14574/ojrnhc.v16i1.368 Method: A systematic review of relevant studies was conducted between 2005 and 2013 using CINAHL Complete and Science Direct within the EBSCOhost Discovery Service and the Cochran Library as outlined by the Preferred Reporting items for Systematic Reviews and Meta-Analyses. Original research articles discussing the health and healthcare among Korean immigrants in the United States were reviewed. Key terms included Korean immigrants, rural, Texas, healthcare, research, and Koreans. Findings: Using various combinations of the key terms, the search produced 243 potential relevant records with only 25 being eligible for review. No studies represented rural regions. Furthermore, only one study was conducted in Texas. Twenty-five records described the state of health and healthcare among Korean immigrants. Topics included socialization, healthcare utilization, cancer screening practices, prevalence of depression, knowledge of hypertension and stroke, and level of physical activity. Conclusions: Despite the review, Korean immigrant’s health and healthcare are still largely unknown, especially when taking rurality into context. Health disparities are more likely to occur in rural medically underserved areas than in urban areas. The presence of such health disparities is even more probable among Korean immigrants. An increased knowledge of the Korean culture is needed among healthcare practitioners to promote health and healthcare among these vulnerable populations. Key words: Korean, Texas, Rural, Health, Healthcare

Burden of Disease Study and Priority Setting in Korea: an Ethical Perspective.

When thinking about priority setting in access to healthcare resources, decision-making requires that cost-effectiveness is balanced against medical ethics. The burden of disease has emerged as an important approach to the assessment of health needs for political decision-making. However, the disability adjusted life years approach hides conceptual and methodological issues regarding the claims and value of disabled people. In this article, we discuss ethical issues that are raised as a consequence of the introduction of evidence-based health policy, such as economic evidence, in establishing resource allocation priorities. In terms of ethical values in health priority setting in Korea, there is no reliable rationale for the judgment used in decision-making as well as for setting separate and distinct priorities for different government bodies. An important question, therefore, is which ethical values guiding the practice of decision-making should be reconciled with the economic evidence found in Korean healthcare. The health technology assessment core model from the European network for Health Technology Assessment (EUnetHTA) project is a good example of incorporating ethical values into decision-making. We suggest that a fair distribution of scarce healthcare resources in South Korea can be achieved by considering the ethical aspects of healthcare.

A Comparison of the Cambodian and the South Korean Health Care System.

The comparison of the healthcare system between these two countries, we can obviously see the health status in South Korea is much better than in Cambodia which has been fighting against communicable diseases such as tuberculosis, malaria, HIV/AIDS, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).4 In order to improve the quality of healthcare in Cambodia, MOH has overall responsibility of the health sector, including: policies, legislation, strategic planning, resource mobilization and allocation, monitoring, evaluation, research, providing training to support the provinces, and coordination of external aid. The MOH's main objective in health sector reform has been to improve and extend primary health services through the implementation of the operational districts system.