1
|
Park S, Ji S, Lee H, Choi H, Choi M, Lee M, Jakovljevic M. Medical expenses and its determinants in female patients with urological disorder. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:45. [PMID: 38790023 PMCID: PMC11127313 DOI: 10.1186/s12962-024-00556-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The rising older adult population has led to an increase in the prevalence of chronic diseases and medical expenses. Women tend to have a longer healthy life expectancy than men and are more likely to be exposed to urological disorders around the age of 50, resulting in substantial healthcare expenses throughout their lifetime. Urological disorders often require continuous treatment owing to their high risk of recurrence, contributing to an increased financial burden from medical costs. This study aimed to identify factors influencing medical expense in female patients with urological disorders and propose strategies to alleviate the associated financial burden. METHODS We used data from the Korea Health Panel Survey conducted from 2011 to 2016. The final sample comprised 2,932 patients who visited hospitals for urological disorders. To identify the factors influencing medical expense among female patients with urological disorders, we employed a generalized estimating equation model. RESULTS The results indicated that younger people and patients with middle-income levels tended to incur higher medical expenses. Furthermore, patients receiving treatment at tertiary hospitals and those enrolled in National Health Insurance also incurred higher health expenses. CONCLUSIONS This study suggests that effective management of medical expenses related to urological disorders in women requires improvements in healthcare accessibility to facilitate early detection and continuous disease management. In addition, the findings highlight the potential benefits of digital health and non-face-to-face treatments in addressing these needs.
Collapse
Affiliation(s)
- Sewon Park
- Department of Medical Science, Ajou University School of Medicine, Suwon, 16499, South Korea
| | - Seokmin Ji
- Department of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, South Korea
| | - Hyunseo Lee
- Department of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, South Korea
| | - Hangseok Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
- Medical Science Research Center, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, South Korea
| | - Mankyu Choi
- Department of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea.
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, South Korea.
| | - Munjae Lee
- Department of Medical Science, Ajou University School of Medicine, Suwon, 16499, South Korea.
| | - Mihajlo Jakovljevic
- UNESCO - The World Academy of Sciences (TWAS), Trieste, Italy
- Shaanxi University of Technology, Hanzhong, Shaanxi, 723099, People's Republic of China
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
| |
Collapse
|
2
|
Jang S, Jeon M, Mun SJ, Kim SH. Clinical characteristics and risk factors for septic shock in patients with pyometra: A retrospective multicenter cohort study. J Infect Public Health 2024; 17:862-867. [PMID: 38554592 DOI: 10.1016/j.jiph.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Pyometra is a disease characterized by the collection of pus in the uterus. The clinical characteristics and etiology of pyometra have not been sufficiently described. In this study, we investigated the clinical characteristics, epidemiology, outcomes, and risk factors of septic shock in patients with pyometra. METHODS Patients with pyometra admitted to one of four university-affiliated hospitals between January 2010 to August 2022 were enrolled. Pyometra cases associated with peripartum infection and surgical site infection were excluded. Clinical characteristics and outcomes of pyometra were described, and pyometra patients with or without septic shock were compared. RESULTS A total of 192 patients was included. Twenty-eight-day all-cause mortality was 5.0%, and the 1-year recurrence rate was 6.3%. Median patient age was 77.5 years. The two most common symptoms were abdominal pain (49.0%) and vaginal discharge (47.9%). Escherichia coli (40.1%), Klebsiella pneumoniae (16.7%), and Streptococcus spp.(16.0%) were the pathogens most frequently isolated by conventional culture; those isolated from polymerase chain reaction were Mycoplasma hominis (48.0%), and Ureaplasma spp. (32.0%). In multivariable analysis, fever, uterine perforation, and dementia were associated with increased incidence of septic shock, while vaginal discharge was associated with a lower incidence of septic shock. CONCLUSIONS Our findings suggest that pyometra is a unique gynecological infectious syndrome in post-menopausal individuals. The most common associated pathogens are similar to those involved in urinary tract infections rather than those of sexually transmitted diseases. Decreased cognitive function could delay early diagnosis of pyometra and lead to septic shock and higher mortality.
Collapse
Affiliation(s)
- Sukbin Jang
- Division of Infectious Diseases, Department of Medicine, Dankook University School of Medicine, Cheonan, Republic of Korea
| | - Minji Jeon
- Division of Infectious Diseases, Department of Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Seok Jun Mun
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Si-Ho Kim
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
| |
Collapse
|
3
|
Kim YJ, So KY, Lee HM, Hahn C, Song SH, Lee YS, Kim SW, Park HC, Ryu J, Lee JS, Kang MJ, Kim J, Lee Y, Lee JH. Changes in dementia treatment patterns associated with changes in the National Policy in South Korea among patients with newly diagnosed Alzheimer's disease between 2011 and 2017: results from the multicenter, retrospective CAPTAIN study. BMC Public Health 2024; 24:168. [PMID: 38216922 PMCID: PMC10787419 DOI: 10.1186/s12889-024-17671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The South Korean government has been actively involved in plans to combat dementia, implementing a series of national strategies and plans since 2008. In July 2014, eligibility for mandatory long-term care insurance (LTCI) was extended to people with dementia enabling access to appropriate long-term care including the cognitive function training program and home nursing service. This study aimed to investigate changes in treatment patterns for Alzheimer's disease (AD) between July 2011 and June 2017 which spanned the 2014 revision. METHODS This multicenter, retrospective, observational study of patients with newly diagnosed AD analyzed electronic medical records from 17 general hospitals across South Korea. Based on their time of AD diagnosis, subjects were categorized into Cohort 1 (1 July 2011 to 30 June 2014) and Cohort 2 (1 July 2014 to 30 June 2017). RESULTS Subjects (N=3,997) divided into Cohorts 1 (n=1,998) and 2 (n=1,999), were mostly female (66.4%) with a mean age of 84.4 years. Cohort 1 subjects were significantly older (P<0.0001) and had a lower number of comorbidities (P=0.002) compared with Cohort 2. Mean Mini-Mental State Examination (MMSE) scores in Cohorts 1 and 2 at the time of AD diagnosis or start of initial treatment were 16.9 and 17.1, respectively (P=0.2790). At 1 year, mean MMSE scores in Cohorts 1 and 2 increased to 17.9 and 17.4, respectively (P=0.1524). Donepezil was the most frequently administered medication overall (75.0%), with comparable rates between cohorts. Rates of medication persistence were ≥98% for acetylcholinesterase inhibitor or memantine therapy. Discontinuation and switch treatment rates were significantly lower (49.7% vs. 58.0%; P<0.0001), and mean duration of initial treatment significantly longer, in Cohort 2 vs. 1 (349.3 vs. 300.2 days; P<0.0001). CONCLUSIONS Comparison of cohorts before and after revision of the national LTCI system for dementia patients found no significant difference in mean MMSE scores at the time of AD diagnosis or start of initial treatment. The reduction in the proportion of patients who discontinued or changed their initial treatment, and the significant increase in mean duration of treatment, were observed following revision of the LTCI policy which enabled increased patient access to long-term care.
Collapse
Affiliation(s)
| | - Ki-Youn So
- Namwon Medical Center, Namwon-si, Jeollabuk-do, South Korea
| | | | | | - Seung-Hoon Song
- Baekje General Hospital, Nonsan-si, Chungcheongnam-do, South Korea
| | - Yong-Seok Lee
- Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | | | - Heui Cheun Park
- Andong Medical Group Hospital, Andong-si, Gyeongsangbuk-do, South Korea
| | - Jaehyung Ryu
- Yeosu Chonnam Hospital, Yeosu-si, Jeollanam-do, South Korea
| | - Jung Seok Lee
- Jeju National University Hospital, Jeju-si, Jeju-do, South Korea
| | - Min Ju Kang
- Veterans Healthcare Medical Center, Seoul, South Korea
| | | | | | - Jun Hong Lee
- National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea.
| |
Collapse
|
4
|
Choi JW, Yoo AJ. Outcomes of the Pilot Project for Community Care Among Older Adults in South Korea. J Aging Soc Policy 2023:1-18. [PMID: 38007618 DOI: 10.1080/08959420.2023.2284571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/27/2023] [Indexed: 11/27/2023]
Abstract
The Korean government implemented the pilot project for community care for older adults in June 2019. This study investigated the outcomes of the pilot project among Korean older adults by linking survey data from the pilot project with data of Korean National Health Insurance Service. The final sample included 17,801 pilot project participants and 68,145 in a matched comparison group. Pilot program participants experienced an increase of 4.8 days for length of home stay and a reduction of $956 (US) per participant relative to the matched comparison group. Pilot program participants with long-term care insurance who used home care services experienced an increase of 8.9 days for length of home stay and a reduction in $1,177 (US) in total costs, along with a reduction in the admission to long-term care facilities, compared to the matched comparison group. Patients discharged from hospitals indicated an increase of 35.2 days for length of home stay and a reduction of $6,947 (US) in total costs, but a 3.53 times increase in hospital readmissions relative to the matched comparison group. The pilot project for community care resulted in increased length of home stay and reduced total costs among older adults in Korea.
Collapse
Affiliation(s)
- Jae Woo Choi
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Gangwon, Korea
| | - Ae Jung Yoo
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Gangwon, Korea
| |
Collapse
|
5
|
Carson A. A Pressure Release Valve: South Korean Long-Term Care Policy as Supplemental to Family Elder Care. J Aging Soc Policy 2023; 35:756-779. [PMID: 36242768 DOI: 10.1080/08959420.2022.2133318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
South Korea's National Long-term Care Insurance (NLTCI) has received international acclaim for its universal continuum-of-care model. Based on 25 qualitative interviews with family caregivers, this research explores the relationship between NLTCI policies and experiences of family caregiving for older people. Caregivers who share care responsibilities or are supported by other family are coping well with minor to moderate policy recommendations. Lone caregivers without support from other family are struggling and express desire for expanded services. These findings highlight a need for more consideration of the influence of family dynamics on informal caregiver burdens. Despite many strengths, NLTCI policy functions as a pressure release valve, supplementing family care for seniors - not replacing it - with minimal gender equity contributions.
Collapse
Affiliation(s)
- Alexa Carson
- PhD Candidate, Department of Sociology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Fong JH. Utilization of Long-Term Care Services and the Role of Institutional Trust in South Korea. J Aging Soc Policy 2023:1-21. [PMID: 37820000 DOI: 10.1080/08959420.2023.2265776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/20/2023] [Indexed: 10/13/2023]
Abstract
With population aging, governments have become increasingly involved in the administration, funding, and regulation of formal long-term care (LTC) systems. We examine the association between institutional trust and formal LTC service utilization among older adults aged ≥60 years with care needs in South Korea's public LTC scheme. Using data from the Korean Longitudinal Study of Aging and hierarchical logistic regressions, we evaluate the respective roles of trust in government and trust in the LTC program on service utilization. Results show that trust in the LTC scheme is significantly associated with service utilization: a unit increase in the level of trust is associated with a 29% increase in the odds of service use on average, controlling for need-related factors (e.g., chronic conditions) and other covariates. Furthermore, the positive relationship between trust and LTC utilization increases in magnitude with age. Older adults who are aged 80 and above, unmarried, with more ADL limitations, with psychiatric disease, or with arthritis are more likely to utilize formal LTC services. Our findings are robust to variations in sample inclusion criteria. Policymakers and health administrators should pay attention to building and maintaining institutional trust in public LTC schemes through good governance and other relevant strategies.
Collapse
Affiliation(s)
- Joelle H Fong
- Assistant Professor, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
| |
Collapse
|
7
|
Cao N, Shi T, Pan C. Does long-term care insurance reduce the disability among middle-aged and older adults? Evidence from China. BMC Public Health 2023; 23:1138. [PMID: 37312092 DOI: 10.1186/s12889-023-16057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
This study aimed to examine whether the implementation of Long-Term Care Insurance (LTCI) policy could reduce the disability among middle-aged and older adults in China, and to test the heterogeneity of the effects. Data came from four waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011 to 2018). The Difference-In-Differences (DID) method and the panel data fixed effect model were used to estimate the effect of implementation of LTCI policy on disability among individuals aged 45 years and above. The LTCI policy had a positive impact on reducing disability among middle-aged and older people. Females, younger adults, city dwellers, and individuals living alone benefited the most from LTCI policy. The results provided empirical evidence for the implementation of LTCI policy in China and other similar countries as China. The implementation of LTCI policy should also pay more attention to inequity of the effects on reducing disability among different demographic groups.
Collapse
Affiliation(s)
- Na Cao
- School of Public Health and Management, Wenzhou Medical University, Wenzhou Medical University Chashan Campus, Wenzhou City, 325035, Zhejiang Province, China
- School of Public Health, Wuhan University, Wuhan City, Hubei Province, China
| | - Tong Shi
- School of Public Health, Wuhan University, Wuhan City, Hubei Province, China
| | - Chaoping Pan
- School of Public Health and Management, Wenzhou Medical University, Wenzhou Medical University Chashan Campus, Wenzhou City, 325035, Zhejiang Province, China.
| |
Collapse
|
8
|
Sempungu JK, Choi M, Lee EH, Lee YH. The Trend of Healthcare Needs among Elders and Its Association with Healthcare Access and Quality in Low-Income Countries: An Exploration of the Global Burden of Disease Study 2019. Healthcare (Basel) 2023; 11:healthcare11111631. [PMID: 37297769 DOI: 10.3390/healthcare11111631] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
To investigate the trend of healthcare needs among elders in low-income countries (LICs) and how changes in healthcare access and quality (HAQ) have correlated with these changes from 1990 to 2019, this study used estimates from the global burden of disease (GBD) 2019 study, including prevalence, years of life lost (YLLs), years lived with disability (YLDs), life expectancy (LE), health-adjusted life expectancy (HALE) and the HAQ index for years 1990 and 2019. We found increases in numbers of YLLs, YLDs, and prevalent cases due to NCDs, and the rate of increase was higher for all indicators of non-communicable diseases (NCDs) when compared with communicable, maternal, neonatal and nutritional diseases among elders. We also observed increases in LE and HALE among all countries. However, this was also challenged by increases in unhealthy life years (ULYs) and their constant percentage of LE. The HAQ index of LICs was also found to be low, although it had increased during the period. A reduction in the burden of acute diseases explains the increase in LE, but increases in ULYs and the NCD burden were also observed. LICs need to improve their HAQ to counter the growing threat of longer but less healthy lives.
Collapse
Affiliation(s)
- Joshua Kirabo Sempungu
- Program in Public Health, Graduate School, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
- Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Minjae Choi
- Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
- Institute for Future Public Health, Graduate School of Public Health, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Eun Hae Lee
- Program in Public Health, Graduate School, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
- Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yo Han Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| |
Collapse
|
9
|
Shin SY, Kwon JH. Translation and Cultural Adaptation of the Preferences for Everyday Living Inventory for Korean Nursing Home Settings. J Gerontol Nurs 2023; 49:5-10. [PMID: 37126014 DOI: 10.3928/00989134-20230413-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Valid and reliable measures are necessary to provide person-centered care. However, there are no such measures in Korean nursing home (NH) settings. The purpose of the current study was to translate and culturally adapt the Preferences for Everyday Living Inventory (PELI) into Korean following the International Society for Pharmacoeconomics and Outcomes Research guidelines. Face validity was assessed by cognitively capable Korean older adults (N = 10) using a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree). Mean score was 2.7 (SD = 0.82) for grammar and wording; 3.7 (SD = 0.48) for understandability; and 3.7 (SD = 0.67) for cultural relevance. Participants found the Korean version of the PELI (PELI-K) easy to understand and interpret, and culturally relevant. Results suggest that the PELI was successfully translated and culturally adapted to Korean. Implementing the PELI-K in Korean NHs and incorporating individual preferences into care delivery will improve quality of care. [Journal of Gerontological Nursing, 49(5), 5-10.].
Collapse
|
10
|
Effects of public long-term care insurance on the medical service use by older people in South Korea. HEALTH ECONOMICS, POLICY, AND LAW 2023; 18:154-171. [PMID: 36189771 DOI: 10.1017/s174413312200024x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Public long-term care insurance (LTCI), which provides home and institutional care benefits, was introduced in July 2008 in South Korea. This study aims to evaluate the effects of the introduction of LTCI on older people's medical service use, including outpatient visits, inpatient services and longer stays (181 days or longer) in hospitals by implementing a quasi-experiment design with a generalised difference-in-difference method. The results showed that the introduction of LTCI did not change the use of outpatient medical services, although the medical costs of older people who used medical services at least once decreased by 9.4%. For the inpatient services, hospitalisation rates declined by 2.7% as a result of the LTCI. Length of stay and inpatient expenses decreased by 15.6 and 9.5%, respectively. For older people of LTC grade 2, eligible for long-term care facilities (LTCF), prolonged hospitalisation rates decreased by 1.6% due to the LTCI. In conclusion, the introduction of LTCI in South Korea has contributed to decreasing the use of inpatient services and longer stays in hospitals, which suggests that the utilisation of LTCF has become a substitute for some social admissions in hospitals.
Collapse
|
11
|
Lee J, Jang SN, Kim CS. Patterns and determinants of health and social care service needs among community-dwelling older adults. Geriatr Nurs 2023; 51:69-75. [PMID: 36921395 DOI: 10.1016/j.gerinurse.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
AIM Using Anderson's behavioral model, we examined the patterns and determinants associated with older adults' needs for community- and institution-based care services. METHODS Participants included 411 community-dwelling older adults from the 2020 National Survey of Older Koreans. Logistic regression analyses were performed to examine factors associated with service needs among older adults. RESULTS The need was greatest for movement support services. Enabling factors (marital status, co-residence with children, receipt of financial assistance for medical expenses, social participation, and satisfaction with healthcare facilities) were associated with service needs. Long-term care beneficiary status, activities of daily living limitations, depressive symptoms, hypertension, and vision impairment were also significant factors. CONCLUSIONS Older adults with physical disabilities, depressive symptoms, and limited resources for care require prioritization in support policies to promote aging in place. Both health and social care needs should be addressed in long-term care to enhance social participation among older adults.
Collapse
Affiliation(s)
- Jakyung Lee
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea.
| | - Soong-Nang Jang
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea; Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
| | - Cheong-Seok Kim
- Department of Sociology, Dongguk University-Seoul, Seoul, Republic of Korea
| |
Collapse
|
12
|
Shin HR, Kim YS, Park YK, Koo SK, Son WH, Han JW, Son EH, Kang HJ, Choi KH, Han JS, Lee HS, Lim HS. Nutritional Status and Frailty Improvement through Senior-Friendly Diet among Community-Dwelling Older Adults in South Korea. Nutrients 2023; 15:nu15061381. [PMID: 36986111 PMCID: PMC10051771 DOI: 10.3390/nu15061381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
Considering that Korea’s aging population is rapidly increasing, health serves as an indicator of older adults’ quality of life, and dietary life directly affects their health. For health maintenance and improvement, preventive healthcare measures including safe food selection and nutritional supply are needed. This study aimed to evaluate the effect of senior-friendly diet on nutrition and health status improvement in older adults receiving community care. A total of 180 older adults were analyzed, with 154 and 26 in the senior-friendly diet intervention group and the general diet group, respectively. Surveys, blood tests, and frailty evaluations were conducted before and after the study. After 5 months of intervention, the blood status, nutrient intake, and frailty level were evaluated. The participants’ mean age was 82.7 years, and 89.4% of them were living alone. In both groups, energy, protein, vitamin A, vitamin D, vitamin C, calcium, and magnesium intake were insufficient initially but generally improved after the intervention. Especially in the intervention group, energy, protein, vitamin D, vitamin C, and folic acid intake significantly increased. The frailty level also slightly improved, and the malnutrition rate was reduced. Even after the passage of time, the improvement effect size significantly differed between the groups. Therefore, resolving and supporting meals corresponding to the physiological needs of the older adults has a great impact on improving their quality of life, and such special consideration is a reasonable way to respond to a super-aged society.
Collapse
Affiliation(s)
- Hye-Ri Shin
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
| | - Young-Sun Kim
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
| | - Yoo-Kyung Park
- Department of Medical Nutrition, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (Y.-K.P.)
| | - Seul-Ki Koo
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
| | - Woo-Hyun Son
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
| | - Jae-Won Han
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
| | - Eun-Ha Son
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
| | - Hae-Jin Kang
- Department of Medical Nutrition, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (Y.-K.P.)
| | - Kyeong-Hee Choi
- The Food Industry Promotional Agency of Korea, Iksan 54576, Republic of Korea
| | - Jin-Soo Han
- The Food Industry Promotional Agency of Korea, Iksan 54576, Republic of Korea
| | - Hyun-Sun Lee
- The Food Industry Promotional Agency of Korea, Iksan 54576, Republic of Korea
| | - Hee-Sook Lim
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea; (H.-R.S.); (Y.-S.K.)
- Correspondence: ; Tel.: +82-31-201-2936
| |
Collapse
|
13
|
Park D, Kim HS, Kim JH. The effect of all-cause hospitalization on cognitive decline in older adults: a longitudinal study using databases of the National Health Insurance Service and the memory clinics of a self-run hospital. BMC Geriatr 2023; 23:61. [PMID: 36721117 PMCID: PMC9890792 DOI: 10.1186/s12877-022-03701-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cognitive decline is common in older adults and imposes a burden on public health. Especially for older adults, hospitalization can be related to decreased physical fitness. This study aimed to investigate the quantitative association between hospitalization and cognitive decline. METHODS This was a retrospective cohort study. We performed a longitudinal study by using the combined database from the Korean National Health Insurance Service (NHIS) and memory clinic data of its self-run hospital. We identified whether hospitalized, the number of hospitalizations, and the total hospitalization days through the claim information from the NHIS database. We also identified whether hospitalization was accompanied by delirium or surgery with general anesthesia for subgroup analysis. Primary outcome was the clinical dementia rating-sum of boxes (CDR-SB) score. Secondary outcomes were mini-mental state examination (MMSE) score, clinical dementia rating (CDR) grade, and Korean-instrumental activities of daily living (KIADL) score. Multivariable mixed models were established. RESULTS Of the 1810 participants, 1200 experienced hospitalization at least once during the observation period. The increase in CDR-SB was significantly greater in the hospitalized group (β = 1.5083, P < .001). The same results were seen in the total number of hospitalizations (β = 0.0208, P < .001) or the total hospitalization days (β = 0.0022, P < .001) increased. In the group that experienced hospitalization, cognitive decline was also significant in terms of CDR grade (β = 0.1773, P < .001), MMSE score (β = - 1.2327, P < .001), and KIADL score (β = 0.2983, P < .001). Although delirium (β = 0.2983, P < .001) and nonsurgical hospitalization (β = 0.2983, P < .001) were associated with faster cognitive decline, hospitalization without delirium and with surgery were also related to faster cognitive decline than in the no hospitalization group. CONCLUSION Cognitive decline was quantitatively related to all-cause hospitalization in older adults. Moreover, hospitalizations without delirium and surgery were also related to cognitive decline. It is vital to prevent various conditions that need hospitalization to avoid and manage cognitive dysfunction.
Collapse
Affiliation(s)
- Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang, South Korea ,grid.49100.3c0000 0001 0742 4007Department of Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang, South Korea
| | - Hyoung Seop Kim
- grid.416665.60000 0004 0647 2391Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Goyang, 10444 Republic of Korea
| | - Jong Hun Kim
- grid.416665.60000 0004 0647 2391Department of Neurology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Goyang, 10444 Republic of Korea
| |
Collapse
|
14
|
Different impact on health outcomes of long-term care insurance between urban and rural older residents in China. Sci Rep 2023; 13:253. [PMID: 36604590 PMCID: PMC9815686 DOI: 10.1038/s41598-023-27576-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
Long-term care insurance (LTCI) is garnering attention internationally and is being considered a public policy in a growing number of countries. Previous research has focused on the effects of LTCI in developed countries, ignoring the health outcomes of developing countries, especially in rural regions. Therefore, this study investigates whether different impact on health outcomes is present in the effects of LTCI between urban and rural residents in China. We employed a quasi-experimental design with data from the China Health and Retirement Longitudinal Survey. The specific implementation time of each pilot city was sorted according to the LTCI policy texts, dividing these pilot cities into the treatment group and control group. Finally, difference-in-differences analyses were utilized to evaluate the health effects of LTCI between urban and rural residents, and the health effect in urban areas was further tested. The implementation of LTCI has effectively enhanced the self-rating health (SRH) of the entire group of residents; however, this effect may only be significant for the urban group. In particular, LTCI can increase the SRH of urban residents by 0.377 units compared to the urban residents without LTCI (P < 0.01). The result of the placebo effect test further verifies that LTCI could improve the health of residents to some extent. In China, LTCI may have triggered different impacts on health outcomes between urban and rural residents, and may not improve the SRH of rural residents and only prove efficacious for urban residents. Government and policy-makers should give more attention to the rural group as it needs long-term care the most.
Collapse
|
15
|
Floridi G, Ko PC, Pinazo-Hernandis S, Sanchez M. Capacity or Necessity? Comparing the Socio-Economic Distribution of Productive Activities Between Italy and South Korea. Res Aging 2023; 45:21-34. [PMID: 35466813 PMCID: PMC9814022 DOI: 10.1177/01640275221089203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Much productive ageing research aims to identify the conditions under which older adults engage in productive roles within and outside the family. This study conceptualises two individual-level explanations for productive participation: capacity and necessity. I hypothesise that whether capacity or necessity prevails across different socio-economic groups depends on the degree of social protection guaranteed by pensions and long-term care systems, which varies across countries. Drawing on data from the SHARE and KLoSA surveys, this study compares socio-economic gradients in full-time work and informal caregiving across cohorts of men and women aged 50-75 in Italy and South Korea in 2006/07 and 2014/15. In Italy, where later-life social protection is generous, productive engagement is more common among wealthier and higher-educated individuals, who have greater capacity to engage in productive roles. In Korea, where social protection is limited, working is more common among socio-economically disadvantaged women, who have higher necessity to remain economically productive.
Collapse
Affiliation(s)
- Ginevra Floridi
- Nuffield College and Leverhulme Centre for Demographic Science, 6396University of Oxford, Oxford, UK
| | | | | | | |
Collapse
|
16
|
Sung W, Kwon HS, Park Y, Kim SH, Park S, Kang DR, Choi H. Gout and the Prevalence of Dementia: A Nationwide Population-Based Study. J Alzheimers Dis 2023; 96:343-349. [PMID: 37781802 DOI: 10.3233/jad-230468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Hyperuricemia in patients with gout is associated with a low risk of neurodegenerative diseases, including dementia. However, the prevalence of dementia in patients with gout has not yet been reported. OBJECTIVE To analyze the prevalence of dementia among patients diagnosed with gout by utilizing the Health Insurance and Review Assessment database, a nationwide registry of the South Korean population. METHODS Data from the Health Insurance and Review Assessment database of patients diagnosed with gout between 2011 and 2018 were extracted. The annual prevalence of dementia according to age and sex was analyzed. We investigated whether there was an association between comorbidities and gout medication in patients with both gout and dementia and in patients with only gout. RESULTS Between 2011 and 2018, the age-adjusted prevalence of dementia per 100,000 persons ranged from 54.0 (95% confidence interval: 47.7-60.2) to 69.9 (95% confidence interval: 65.3-74.5). Compared to previous studies, the prevalence of dementia was lower in patients with gout than in the general population. Patients with both gout and dementia were more likely to be women, have a wide range of comorbidities, and be prescribed gout-related drugs, including allopurinol, febuxostat, nonsteroidal anti-inflammatory drugs, and steroids than patients with gout without dementia. CONCLUSIONS This study demonstrated a relatively low prevalence of dementia in patients with gout. Gout, characterized by hyperuricemia, might be associated with a reduced risk of dementia.
Collapse
Affiliation(s)
- Wonjae Sung
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Sung Kwon
- Department of Neurology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Yeonjae Park
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seung Hyun Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sojeong Park
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Republic of Korea
| | - Dae Ryong Kang
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hojin Choi
- Department of Neurology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| |
Collapse
|
17
|
Impact of long-term care insurance on medical costs and utilization by patients with Parkinson's disease. Soc Sci Med 2023; 317:115563. [PMID: 36455406 DOI: 10.1016/j.socscimed.2022.115563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/09/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In patients with Parkinson's disease (PD), long-term care insurance (LTCI), which can provide physical activity, might affect medical costs and utilization. We investigated the impact of LTCI on medical costs and utilization among patients with PD aged ≥60 years. METHODS Data were derived from the 12-year Korean National Health Insurance Service‒Senior cohort. Among patients with newly developed PD, the intervention group receiving LTCI was matched with the control group using propensity score risk-set matching. As medical costs and utilization may increase markedly immediately before LTCI allocation, the baseline period was set from 5 years to 1 year prior to receiving LTCI. Medical costs and utilization were recorded in six 1-year intervals thereafter. We compared medical costs and utilization between groups using a comparative interrupted time-series analysis. RESULTS 5011 LTCI beneficiaries and 5011 propensity score- and risk-set-matched controls were included. The overall mean (standard deviation) age was 77.73 (5.7) years, and 66.2% were women, in both groups. LTCI benefit was associated with reduced overall direct medical costs for 5 years (post-intervention year 5: -270$, p = 0.033), and overall hospital length-of-stay (LOS) for 2 years post-LTCI (post-intervention year 2: -2.43 days, p = 0.002), although medical costs and LOS increased immediately pre-LTCI implementation. The long-term care hospital LOS of LTCI beneficiaries increased relatively by 3-years post-LTCI implementation, particularly in those with a high Charlson Comorbidity Index score (post-intervention year 3: +2.65 days, p = 0.04). CONCLUSIONS LTCI benefit stably decreased medical costs for patients with PD for 5 years, despite the steep increase immediately pre-LTCI benefit, but was limited in reducing medical utilization, particularly as reflected by LOS in long-term care hospitals and patients with comorbidities. LTCI could be a useful health policy to reduce PD disease burden. However, further development is required to provide services that can reduce LOS to PD patients with comorbidities.
Collapse
|
18
|
Cho KH, Park JB, Jung YH. Effects of Service Quality Characteristics of Neighborhood Sports Facilities on User Satisfaction and Reuse Intention of the Elderly during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14606. [PMID: 36361484 PMCID: PMC9653674 DOI: 10.3390/ijerph192114606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE this study aimed to examine the user satisfaction and reuse intention of the elderly for neighborhood sports facilities in South Korea during the COVID-19 pandemic. METHODS this study surveyed 386 Korean elderly individuals aged ≥ 65 years, who were users of neighborhood sports facilities, from 1 May to 31 August 2022. A total of 386 questionnaires were used for data analysis, which was carried out using SPSS 23.0 statistical software. Descriptive statistics of the mean, standard deviation, and frequency distribution were used at the descriptive level. Moreover, one-way analysis of variance (ANOVA), Scheffe's post hoc pair-wise comparison analysis, Pearson's correlation coefficient, and multiple regression analysis were used at the inferential level. The significance level of these tests was considered for less than 0.05. RESULTS the mechanistic and humanistic service factors of neighborhood sports facilities affected user satisfaction and reuse intention. Furthermore, user satisfaction of the elderly during the COVID-19 pandemic had a positive effect on reuse intention. CONCLUSION this study confirmed that the service quality characteristics of neighborhood sports facilities during the COVID-19 pandemic had a positive effect on user satisfaction and intention to continue to exercise among the elderly.
Collapse
Affiliation(s)
- Kyoung Hwan Cho
- Department of Special Physical Education, Daelim University College, Anyang-si 13916, Korea
| | - Jeong-Beom Park
- Department of Special Physical Education, Daelim University College, Anyang-si 13916, Korea
| | - Yang Hun Jung
- Department of Special Physical Education, Hanshin University, Osan-si 18101, Korea
| |
Collapse
|
19
|
Yeh MJ. Developmental trajectories of health and long-term care systems: The transitions of solidarity in four Asian countries. Arch Gerontol Geriatr 2022; 103:104785. [PMID: 35944465 DOI: 10.1016/j.archger.2022.104785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Different from the development of health sector, there are significant variations in the underpinnings and formation timings of solidarity-based long-term care (LTC) systems. This paper compares the historical developmental trajectories and identifies factors of the transitions of the actual practices of solidarity - the scope of community, the scope of interdependence, and the costs of joint action - in the health and LTC sectors in four East Asian countries: Japan, South Korea, Taiwan, and Singapore. METHODS Comparative policy analysis. RESULTS Healthcare tends to be considered a universal value such that its boundary should include all residents, while LTC is closer to an entitlement of citizens. The differing solidarity reflects path dependency as well as historical legacies and policy diffusion between the health and LTC sectors. In both health and LTC sectors, the costs involved in collective service provision are not distributed evenly between generations. DISCUSSION Centralized governance is a prevailing feature of health and LTC sectors in East Asia, allowing solidarity-based institutional arrangements to be established without an overall sense of solidarity. The relationship between solidarity and health and LTC systems is complex and dynamic.
Collapse
Affiliation(s)
- Ming-Jui Yeh
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, 17 Xuzhou Road, Taipei 10055, Taiwan.
| |
Collapse
|
20
|
Güdük Ö. Determining the prevalence of functional limitation and the factors affecting it among older adults in need of long-term care in Turkey. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2118184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Özden Güdük
- Yüksek İhtisas Üniversitesi: Yuksek Ihtisas Universitesi, Ankara, Turkey
| |
Collapse
|
21
|
Han YH, Yoo SH, Lee SY, Hwang IY, Kim KH, Cho B, Kim MS, Choi W, Kim Y. The Medical Needs and Characteristics of Cancer and Progressive Neurologic Disease Patients Who Use Home-Based Medical Care in Korea: A Retrospective Study for 2011-2020. J Am Med Dir Assoc 2022; 23:1634-1641.e2. [PMID: 35926572 DOI: 10.1016/j.jamda.2022.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/08/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the needs and characteristics of patients with cancer and neurologic disorders requiring home-based medical care (HBMC). DESIGN Retrospective observational study. SETTING AND PARTICIPANTS Patients receiving HBMC on discharge from a tertiary hospital in Korea during 2011-2020. METHODS Patients were classified into 3 disease groups: cancer, progressive neurologic disorders (NR), and others. Characteristics and medical needs were assessed in each disease group. Medical needs were categorized based on functional items requiring support or management at the time of registration: respiratory, feeding, urinary system, drain tube, central catheter, wound, medication, and other. Patients with multiple medical needs were assigned to multiple categories. Patients who used HBMC for more than 3 months were defined as long-term users; their characteristics were evaluated in the same way. RESULTS Of the total 655 patients, 47.0% (308) had cancer and 17.3% (113) were NR patients. Among all patients, 78.8% were partially dependent (44.0%) or completely dependent (34.8%) in daily activities, and there were more dependent patients in the NR group (80.5%) than cancer (26.6%). Patients with cancer needed central catheter management the most (43.5%), followed by wound care (36.7%), feeding support (35.1%), and drain tube management (22.1%). NR patients required feeding support the most (80.5%), followed by respiratory support (43.4%), wound care (41.6%), and urinary system support (19.5%). Of all patients, 30.2% (198) were long-term users (NR, 37.9%; cancer, 35.4%). Long-term users were common among patients who needed respiratory support (59.4%), feeding support (48.75), and urinary system support (34.6%). CONCLUSIONS AND IMPLICATIONS Homebound patients with cancer and progressive neurologic disorders need medical services at home after discharge. Patients who need feeding and respiratory support usually use HBMC for more than 3 months. Further studies are needed to design an optimal HBMC that continuously provides medical services to patients with serious illnesses living at home.
Collapse
Affiliation(s)
- Yo Han Han
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shin Hye Yoo
- Center for Palliative care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; College of Medicine, Seoul National University, Seoul, Republic of Korea.
| | - In Young Hwang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Belong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Sun Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wonho Choi
- Center for Palliative care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yejin Kim
- Center for Palliative care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
22
|
Villalobos Dintrans P, González Bautista E. Functional Dependency in Mexico: Measurement Issues and Policy Challenges. Int J Health Policy Manag 2022; 11:1017-1023. [PMID: 33589566 PMCID: PMC9808163 DOI: 10.34172/ijhpm.2020.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/01/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Different definitions have been used to measure functional dependency (FD) in Mexico. This study aims to explore if different definitions of FD lead to low consistency between the estimations of its prevalence. Accurate estimations of FD are useful to estimate the potential demand for long-term care (LTC) services in the country. METHODS A literature review including documents with estimations on the number or prevalence of dependents in Mexico with national representativeness between 2000 and 2019 was performed as well as estimations of different definitions of FD, using the National Study on Health and Aging in Mexico (ENASEM). RESULTS There is a lack of consensus on the definition of FD. Among the most frequently used terms to define FD are "disability" and "dependency." The heterogeneity of definitions results in a wide range of estimations of the demand for LTC. Methodological choices can lead to important differences in FD prevalence estimations. Results from ENASEM 2001 show that FD prevalence could range from 13% to 35% in people 60+; sex prevalences also vary when using different ways to measure FD. CONCLUSION Besides the highlighted issues in calculating FD in the population, Mexico should consider broadening the assessment of FD, including people with dementia and younger populations. Although the literature search is not systematic, it helps exemplifying the current issues when measuring FD in Mexico. A consensual definition of dependency is required to have a more accurate estimated demand for LTC. Having good data sources is not enough when dissimilar estimations of an indicator like dependency result from the same study. Wide heterogeneity in estimations of dependency could be an obstacle to inform public policies during the construction of a care system in Mexico.
Collapse
Affiliation(s)
- Pablo Villalobos Dintrans
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santiago, Chile
| | | |
Collapse
|
23
|
Zhao B, Kong F, Shin DE, Nam EW. Gender Disparity and the Association Between Socioeconomic Status, Mental Health, and the Need for Long-Term Services and Support Among the Older Koreans. Front Public Health 2022; 10:888011. [PMID: 35719606 PMCID: PMC9203953 DOI: 10.3389/fpubh.2022.888011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/06/2022] [Indexed: 12/05/2022] Open
Abstract
Background Population aging-the inevitable increase in the percentage of older adults-is occurring all around the world as the fertility rate declines and life expectancy rises. This study examined the relationship between socioeconomic status (SES), mental health, and the need for long-term services and support (LTSS) among Korean older adults. It also aimed to provide evidence-based information for South Korea's long-term support services and programs. Methods This study used the data on older adults aged over 60 years from the 2018 Korean Longitudinal Study of Aging (KLoSA). Ultimately, 5,527 older adults were included in the database (42.6% men, 57.4% women). To clarify the association between SES, mental health, and the need for LTSS among older Korean men and women, chi-squared test, t-test, and structural equation modeling (SEM) were performed. Results The SEM analysis showed that a significant, negative association was observed between SES and the need for LTSS among these older adults-the higher SES groups would generally have less need for LTSS. Mental health had a strong, negative impact on the need for LTSS-better mental health status of the older individuals would indicate a lower need for LTSS, and the effect was stronger among older men. Meanwhile, the positive relationship between SES and mental health was verified-the higher the SES of these older adults the better their mental health. Conclusions Gender- and social class-sensitive impacts of mental health on the need for LTSS were observed in this study. These findings could provide an evidence-based reference for interventions targeting different genders and social classes in Korea's long-term care system, such as the enhancement of social welfare and mental health status of the older adults.
Collapse
Affiliation(s)
- Bo Zhao
- Department of Health Administration, Graduate School, Yonsei University, Wonju, South Korea
- Yonsei Global Health Center, Yonsei University, Wonju, South Korea
| | - Fanlei Kong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Dong Eun Shin
- Yonsei Global Health Center, Yonsei University, Wonju, South Korea
| | - Eun Woo Nam
- Department of Health Administration, Graduate School, Yonsei University, Wonju, South Korea
- Yonsei Global Health Center, Yonsei University, Wonju, South Korea
| |
Collapse
|
24
|
Hu B, Shin P, Han EJ, Rhee Y. Projecting Informal Care Demand among Older Koreans between 2020 and 2067. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116391. [PMID: 35681979 PMCID: PMC9180884 DOI: 10.3390/ijerph19116391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 02/01/2023]
Abstract
Background: The number of Korean older people receiving informal care is expected to rise sharply due to aging population. This study makes projections of demand for informal care in community-dwelling older people aged 65 and over in Korea until 2067. Method: The study drew on data collected from waves 4–6 of the Korean Longitudinal Study of Aging (2012–2016, n = 12,975). Population data published by Statistics Korea and data from the Long-term Care Insurance Statistical Yearbook for Korea were also used. A macro-simulation model was built to make the projections. Results: The number of older people receiving informal care will increase from 0.71 million in 2020 to 2.2 million in 2067. Demand for informal care from adult children or relatives is projected to rise by 257%, much faster than the increase in demand for spousal care (164%). The estimates are sensitive to alternative assumptions about future mortality rates, fertility rates, patterns of migration, and the prevalence of functional disabilities in the population. Conclusion: Demand for informal care in Korea will rise substantially in the coming decades, and the increase will be uneven for different groups of care users. Our analyses are not only relevant to the long-term care system for the general older population but also have profound implications for intensive users of long-term care in Korea. The findings highlight the importance of accurate identification of unmet needs in the population and timely delivery of government support to older people and their informal caregivers.
Collapse
Affiliation(s)
- Bo Hu
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, UK;
| | - Peter Shin
- Milken Institute School of Public Health, Department of Health Policy and Management, George Washington University, Washington, DC 20052, USA;
| | - Eun-jeong Han
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju 26464, Korea;
| | - YongJoo Rhee
- Department of Health Sciences, Dongduk Women’s University, Seoul 02748, Korea
- Department of Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Correspondence:
| |
Collapse
|
25
|
Lee HY, Oh J, Kawachi I. Changes In Catastrophic Health Expenditures For Major Diseases After A 2013 Health Insurance Expansion In South Korea. Health Aff (Millwood) 2022; 41:722-731. [PMID: 35500181 DOI: 10.1377/hlthaff.2021.01320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The South Korean National Health Insurance scheme has lacked sufficient coverage scope (services covered) and depth (costs covered) since it achieved national coverage in 1989. The government implemented two separate welfare plans (2004-08 and 2009-12) to improve the financial protection of National Health Insurance by mainly focusing on costs covered. The third plan (initiated in 2013) was the most comprehensive, addressing both scope and depth. We evaluated the impact of this benefit expansion policy for four categories of major disease (cancer, cardiac disease, cerebrovascular disease, and rare diseases) on catastrophic health expenditures, impoverishment, and unmet need. Using 2012-17 Korean Health Panel Survey data, we performed difference-in-differences analyses and triple-difference analyses to examine the differential impact of policy across income groups. The policy reduced catastrophic health expenditures among beneficiary households across almost all postpolicy years. However, there was no average effect on reducing household impoverishment or unmet need. The policy had mixed effects by income but did not generally favor low-income households. To provide stronger financial protection, the policy must address issues beyond expanding coverage, such as provider payment structure. In addition, special policy measures for low-income households need to be adopted.
Collapse
Affiliation(s)
- Hwa-Young Lee
- Hwa-Young Lee, Harvard University, Boston, Massachusetts
| | - Juhwan Oh
- Juhwan Oh , Seoul National University, Seoul, South Korea
| | | |
Collapse
|
26
|
Public Health Financing and Responses to COVID-19: Lessons from South Korea. Healthcare (Basel) 2022; 10:healthcare10040750. [PMID: 35455927 PMCID: PMC9030522 DOI: 10.3390/healthcare10040750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 12/04/2022] Open
Abstract
Health financing strategies contribute significantly to containing the outbreak of the Coronavirus disease 2019 (COVID-19). This study aims to reassess Korea’s financing strategies in response to COVID-19 in 2020, to ascertain its effects and sustainability. The Joint External Evaluation tool was adopted to analyze the data collected from government reports, official statistics, and other sources. Findings show that Korea could maintain a low incidence and fatality rate compared with other countries, at low costs. It was a result of rapidly procured healthcare resources based on laws and policies established after the 2015 epidemic, and the National Health Insurance. However, to achieve long-term sustainability, it is important to enhance the financial stability of the national health insurance and increase the proportion of the public sector in healthcare resources.
Collapse
|
27
|
Financial Integration Scenario for Community Integrated Care: Focusing on the Case of Korea. Int J Integr Care 2022; 22:18. [PMID: 35693296 PMCID: PMC9165675 DOI: 10.5334/ijic.6465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
This study analyzes the potential effects of a reform based on community integrated care in Korea, which is experiencing a high rate of population aging, and a specific method for financial integration. We first analyze the size and trend of funds used for the care for the elderly out of Korea’s health insurance, long-term care insurance, and national budget. We then analyze the amount of financial resources required and the cost-saving effect when the related financial resources are converted into local community care funds. This approach sheds light on the possibility of harmonizing healthcare policy for the elderly and integrated care under the existing insurance system and suggests a direction for reform in policies pertaining to healthcare for the elderly. Given that the same services are provided, we find that combining the finances from the insurance and the national budget would result in a fund of KRW 2.6 trillion to KRW 4.7 trillion. This approach also confirms that health care costs for the elderly can be reduced by 1-5% in the long term, which we estimate to be between KRW 1 trillion to KRW 4 trillion by 2050. We find that by tapping into the national budget to manage the pre-medical stage care, we can utilize an efficient operation mechanism unlike insurance. We also confirm that information exchange and harmonious operation between the national budget and state-run insurance as well as feedback and incentives through performance management are necessary for these results to become a reality.
Collapse
|
28
|
The Institutional Factors Affecting the Growth of Korean Migrant Care Market and Sustainability in Long-Term Care Quality. SUSTAINABILITY 2022. [DOI: 10.3390/su14063366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Due to an increase in the ageing population, the migrant care market now includes new home-based long-term care (LTC) under the national long-term care insurance. This study underlines a perspective of the Korean migrant care market in terms of long-term care quality in South Korea. Thus, the study explored the institutional factors that restrict and promote the migrant care workers (MCWs). Two migrant workers groups were analysed: migrant care workers in home-based long-term care versus nursing hospitals. Designed as an in-depth policy-oriented content analysis, this study used three types of data including interviews with eight participants (MCWs, the nursing hospital manager, and the LTC home manager), organisational documents (employment eligibility criteria), and institutional texts (law, administration rules, etc.). Our results indicate that the factors hindering employment of MCWs in home-based LTC were visa status, qualification requirements (the National Qualified License), wage regulation policies, and social security obligations. A promoting factor was jobs that hired on an on-call basis. In conclusion, our findings suggest that the growth of the migration care market and sustainability in LTC quality depend on the policy directions of the Korean long-term care insurance.
Collapse
|
29
|
Lee C, Yi JS. Socioeconomic Classes among Oldest-Old Women in South Korea: A Latent Class Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413183. [PMID: 34948797 PMCID: PMC8701893 DOI: 10.3390/ijerph182413183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Abstract
Oldest-old women are known to live at the intersection of multiple socioeconomic disadvantages in South Korean society. This study classified oldest-old Korean women into several socioeconomically homogeneous classes based on various socioeconomic status (SES) risks and compared health characteristics among the identified classes. This cross-sectional study utilized the 2019 Korean Community Health Survey, including data from 11,053 women (≥80 years). Latent class analysis determined the number of underlying socioeconomic classes based on nine selected SES variables. Four distinct socioeconomic classes were identified: “Urban, living alone, recipient of NBLSS, moderate education, leisure activity” (Class 1), “Rural, traditional house, living with others, not financially deprived, low education, employed” (Class 2), “Urban, living with family, financially affluent, not employed, no barriers to healthcare” (Class 3), “Rural, traditional house, living alone, financially deprived, uneducated, employed, barriers to healthcare” (Class 4). Depressive symptoms, subjective stress, and the prevalence of sleep disorder and diabetes were higher in Class 1 compared to other classes. Health-related quality of life, perceived health, and self-rated oral health were the poorest in Class 4. Class 3 reported the best health status. Understanding the intersecting SES risk factors in this group can aid in developing targeted interventions.
Collapse
Affiliation(s)
- Chiyoung Lee
- School of Nursing & Health Studies, University of Washington Bothell, Bothell, WA 98011, USA;
| | - Jee-Seon Yi
- Institute of Health Sciences, College of Nursing, Gyeongsang National University, Jinju 52727, Korea
- Correspondence: ; Tel.: 82-55-772-8252
| |
Collapse
|
30
|
Preker AS, Cotlear D, Kwon S, Atun R, Avila C. Universal health care in middle-income countries: Lessons from four countries. J Glob Health 2021; 11:16004. [PMID: 34912557 PMCID: PMC8645236 DOI: 10.7189/jogh.11.16004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In this paper, we review lessons learned about Universal Health Coverage (UHC) in middle-income countries, with specific reference to achievements and challenges observed during recent years in four middle-income to upper-middle-income countries - Mexico, Turkey, The Republic of Korea and Ukraine. Three of these countries - Mexico, the Republic of Korea, Turkey are members of the Organization for Economic Cooperation and Development (OECD). Ukraine has aspired to join Western institutions like the OECD since its independence in 1991. METHODS The research included a combination of cross-sectional and longitudinal reviews of both statistical and contextual data, available from both published sources and available "grey literature" reports. RESULTS Based on the research, we conclude the following. First, reaching UHC is achievable in middle-income and upper-middle-income countries. It is not an unattainable goal reserved for upper income countries. Second, successes and failures are evident both in the case of countries that pursue a contributory health insurance path to UHC and those that pursue a core government funding path. Third, the devil is often in the detail. De jure constitutional guarantees and national health legislation are often a necessary but do not constitute a guaranteed path to success without accompanying institutional measure to secure sustainability (political and economic) and supply and demand constraints in service provision and consumer/patient behavior. De facto, in most countries expansion in health insurance coverage does not happen "with the stroke of a pen" but require years of commitment and efforts to change the supply and demand after critical legislation has been enacted. Fourth, two major approaches dominate: incremental and "big bang" health system reforms. CONCLUSIONS We caution against the pitfalls of over-attribution from drawing too strong conclusion from individual longitudinal country experiences ("over-determinism") and over-generalization from broad sweeping cross-sectional statistical analysis ("reductionism"). Every country is different and needs to find its own path towards UHC considering their contextual specificities, learning from the achievements and failures of others, but not try to copy their experiences.
Collapse
Affiliation(s)
| | | | - Soonman Kwon
- Graduate School of Public Health, Department of Health Policy and Management, Professor and Former Dean, Seoul National University, Seoul, South Korea
| | - Rifat Atun
- T.H. Chan School of Public Health, Department of Global Health and Population, Director of Global Health Systems Cluster/Professor of Global Health Systems, Harvard University, Boston, Massachusetts, USA
| | | |
Collapse
|
31
|
Villalobos Dintrans P, Mathur M, González-Bautista E, Browne J, Hommes C, Vega E. Implementing long-term care systems in the Americas: a regional strategy. Rev Panam Salud Publica 2021; 45:e86. [PMID: 34475883 PMCID: PMC8369132 DOI: 10.26633/rpsp.2021.86] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
The Region of the Americas is facing accelerated demographic and epidemiological changes. As these trends will continue in future years, long-term care needs are expected to rise. How can countries respond to these challenges? We propose that countries in the Region should invest in the implementation of long-term care systems. Considering the heterogeneity in the Region, we propose a strategy based on three components: (i) understanding the problem; (ii) thinking about solutions; and (iii) building support and consensus. Depending on each country's needs and capacities, these three elements suggest short-term and long-term actions and goals, from generating better information on long-term care needs to the implementation of long-term care systems. Long-term care is a relevant issue for the Region today. The task is challenging, but countries need to embrace it and move forward before it is too late.
Collapse
Affiliation(s)
| | - Mallika Mathur
- Independent consultantWashington, D.C.United States of AmericaIndependent consultant, Washington, D.C., United States of America
| | - Emmanuel González-Bautista
- Toulouse University Hospital (CHU Toulouse)ToulouseFranceToulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Jorge Browne
- Pontificia Universidad Católica de ChileSantiagoChilePontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Hommes
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Enrique Vega
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| |
Collapse
|
32
|
Abstract
Context: With the increasing number of the elderly suffering from chronic diseases and disabilities, elderly long-term care (LTC) has been the subject of attention by health and welfare policymakers. This study aimed to compare the components of LTC for the elderly in Iran and selected countries. Methods: This comparative study was conducted in 2020. The search was conducted in three databases (PubMed, Scopus, and Web of Science), two search engines (Google Scholar and Google), and the websites of WHO and the Ministry of Health and Welfare of the selected countries from 2000 to 2020 to find relevant documents on the subject. The selection of countries was based on three criteria: the type of health system, having the highest percentage of the elderly population, and the development status. Finally, Germany, France, Sweden, Japan, South Korea, Turkey, Thailand, and Iran were included in the study. The findings were organized using a common LTC framework. Results: In this study, the common framework of LTC systems, including beneficiaries, benefits packages, providers, and financing, was used. The study results showed that developed countries had formal LTC systems with specific mechanisms, but each country had differences in the implementation of different components of this system. On the other hand, in most developing countries, sporadic measures were taken in this field. Conclusions: In general, developed countries have adopted different LTC system approaches in the organization, financing, type of services, and generosity of benefits. In choosing the appropriate LTC model in developing countries, factors such as the health system, resource constraints, social, and cultural status should be considered.
Collapse
|
33
|
Kim H, Cheng SH, Yamana H, Lee S, Yoon NH, Lin YC, Fushimi K, Yasunaga H. Variations in hip fracture inpatient care in Japan, Korea, and Taiwan: an analysis of health administrative data. BMC Health Serv Res 2021; 21:694. [PMID: 34256758 PMCID: PMC8278699 DOI: 10.1186/s12913-021-06621-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about hip fracture inpatient care in East Asia. This study examined the characteristics of patients, hospitals, and regions associated with delivery of hip fracture surgeries across Japan, Korea, and Taiwan. We also analyzed and compared how the resource use and a short-term outcome of the care in index hospitals varied according to factors in the respective health systems. METHODS We developed comparable, nationwide, individual-level health insurance claims datasets linked with hospital- and regional-level statistics across the health systems using common protocols. Generalized linear multi-level analyses were conducted on length of stay (LOS) and total cost of index hospitalization as well as inpatient death. RESULTS The majority of patients were female and aged 75 or older. The standardized LOS of the hospitalization for hip fracture surgery was 32.5 (S.D. = 18.7) days in Japan, 24.7 (S.D. = 12.4) days in Korea, and 7.1 (S.D. = 2.9) days in Taiwan. The total cost per admission also widely varied across the systems. Hospitals with a high volume of hip fracture surgeries had a lower LOS across all three systems, while other factors associated with LOS and total cost varied across countries. CONCLUSION There were wide variations in resource use for hip fracture surgery in the index hospital within and across the three health systems with similar social health insurance schemes in East Asia. Further investigations into the large variations are necessary, along with efforts to overcome the methodological challenges of international comparisons of health system performance.
Collapse
Affiliation(s)
- Hongsoo Kim
- Graduate School of Public Health Department of Public Health Science, Institute of Health and Environment, & Institute of Aging, Seoul National University, Seoul, 08826, South Korea.
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, Population Health Research Center, National Taiwan University, Taipei, Taiwan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seyune Lee
- Graduate School of Public Health, Department of Public Health Sciences, Seoul National University, Seoul, South Korea
| | - Nan-He Yoon
- Division of Social Welfare and Health Administration, Wonkwang University, Iksan, Jeonbuk, South Korea
| | - Yi-Chieh Lin
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
34
|
Chun H, Das Gupta M. ‘Not a bowl of rice, but tender loving care’: from aborting girls to preferring daughters in South Korea. ASIAN POPULATION STUDIES 2021. [DOI: 10.1080/17441730.2021.1944408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Heeran Chun
- Department of Health Administration, Jungwon University, Chungbuk, South Korea
| | - Monica Das Gupta
- Department of Sociology and Maryland Population Research Center, University of Maryland, College Park, MD, USA
| |
Collapse
|
35
|
Type of bystander and rate of cardiopulmonary resuscitation in nursing home patients suffering out-of-hospital cardiac arrest. Am J Emerg Med 2021; 47:17-23. [PMID: 33752168 DOI: 10.1016/j.ajem.2021.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/21/2021] [Accepted: 03/07/2021] [Indexed: 11/22/2022] Open
Abstract
AIM We investigated bystander cardiopulmonary resuscitation (CPR) provision rate and survival outcomes of out-of-hospital cardiac arrest (OHCA) patients in nursing homes by bystander type. METHODS A population-based observational study was conducted for nursing home OHCAs during 2013-2018. The exposure was the bystander type: medical staff, non-medical staff, or family. The primary outcome was bystander CPR provision rate; the secondary outcomes were prehospital return of spontaneous circulation (ROSC) and survival to discharge. Multivariable logistic regression analysis which corrected for various demographic and clinical characteristics evaluated bystander type impact on study outcomes. Bystander CPR rate trend was investigated by bystander type. RESULTS Of 8281 eligible OHCA patients, 26.0%, 70.8%, and 3.2% cases were detected by medical staff, non-medical staff, and family, respectively. Provision rate of bystander CPR was 69.9% and rate of bystander defibrillation was 0.4% in total. Bystander CPR was provided by medical staff, non-medical staff, and families in 74.8%, 68.9%, and 52.1% respectively. Total survival rate was 2.2%, out of which, 3.3% was for medical staff, 3.2% for non-medical staff, and 0.6% for family. Compared to the results of detection by medical staff, the adjusted odds ratios (95% CIs) for provision of bystander CPR were 0.56 (0.49-0.63) for detection by non-medical staff and 0.33 (0.25-0.44) for detection by family. The bystander CPR rates of all three groups increased over time, and among them, the medical staff group increased the most. For prehospital ROSC and survival to discharge, no significant differences were observed according to bystander type. CONCLUSION Although OHCA was detected more often by non-medical staff, they provided bystander CPR less frequently than the medical staff did. To improve survival outcome of nursing home OHCA, bundle interventions including increasing the usage of automated external defibrillators and expanding CPR training for non-medical staff in nursing home are needed.
Collapse
|
36
|
Choi JI, Cho YH, Kim YJ, Lee SY, Lee JG, Yi YH, Tak YJ, Hwang HR, Lee SH, Park EJ, Lee YI, Ra YJ, Lee SJ. The Relationship of Sitting Time and Physical Activity on the Quality of Life in Elderly People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1459. [PMID: 33557349 PMCID: PMC7916059 DOI: 10.3390/ijerph18041459] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Abstract
Few studies have shown the combined impact of sitting time and physical activity on quality of life in older people. This cross-sectional study, using data from the 2016-2018 Korean National Health and Nutrition Examination Survey, examines the association between sitting time and physical activity and health-related quality of life (HRQoL) in Korean adults aged ≥ 65 years. HRQoL was assessed using the EuroQol-5 Dimension (EQ-5D, three-level version). We divided subjects into groups based on sitting time and physical activity and analyzed the combined association of sitting time and physical activity with HRQoL. The association between longer sitting time (≥8 h) and HRQoL was analyzed using multiple logistic regression. In total, 4276 participants were included. Prolonged sitting time was associated with all of the EQ-5D dimensions: mobility (odds ratio [OR]: 1.43, 95% confidence interval [CI]: 1.22-1.68), self-care (OR: 1.65 [95% CI 1.25-2.17]), usual activities (OR: 2.07 [95% CI 1.69-2.52]), pain/discomfort (OR: 1.57 [95% CI 1.34-1.84]), and anxiety/depression (OR: 1.49 [95% CI 1.17-1.91]). The prolonged sitting time/inactive group had higher ORs for all the EQ-5D dimensions than the low sitting time/active group. Prolonged sitting time was associated with low HRQoL in elderly Korean adults; physical activity could weaken the negative influence of prolonged sitting time on HRQoL.
Collapse
Affiliation(s)
- Jung In Choi
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea; (J.I.C.); (S.Y.L.); (E.J.P.); (Y.I.L.)
| | - Young Hye Cho
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea; (J.I.C.); (S.Y.L.); (E.J.P.); (Y.I.L.)
| | - Yun Jin Kim
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan 50612, Korea; (Y.J.K.); (J.G.L.); (Y.H.Y.); (Y.J.T.); (H.R.H.); (S.H.L.); (Y.J.R.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Sang Yeoup Lee
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea; (J.I.C.); (S.Y.L.); (E.J.P.); (Y.I.L.)
- Department of Medical Education, Pusan National University School of Medicine, Yangsan 50612, Korea
| | - Jeong Gyu Lee
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan 50612, Korea; (Y.J.K.); (J.G.L.); (Y.H.Y.); (Y.J.T.); (H.R.H.); (S.H.L.); (Y.J.R.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Yu Hyeon Yi
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan 50612, Korea; (Y.J.K.); (J.G.L.); (Y.H.Y.); (Y.J.T.); (H.R.H.); (S.H.L.); (Y.J.R.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Young Jin Tak
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan 50612, Korea; (Y.J.K.); (J.G.L.); (Y.H.Y.); (Y.J.T.); (H.R.H.); (S.H.L.); (Y.J.R.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Hye Rim Hwang
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan 50612, Korea; (Y.J.K.); (J.G.L.); (Y.H.Y.); (Y.J.T.); (H.R.H.); (S.H.L.); (Y.J.R.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Seung Hun Lee
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan 50612, Korea; (Y.J.K.); (J.G.L.); (Y.H.Y.); (Y.J.T.); (H.R.H.); (S.H.L.); (Y.J.R.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Eun Ju Park
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea; (J.I.C.); (S.Y.L.); (E.J.P.); (Y.I.L.)
| | - Young In Lee
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea; (J.I.C.); (S.Y.L.); (E.J.P.); (Y.I.L.)
| | - Young Jin Ra
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan 50612, Korea; (Y.J.K.); (J.G.L.); (Y.H.Y.); (Y.J.T.); (H.R.H.); (S.H.L.); (Y.J.R.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Su Jin Lee
- Department of Internal Medicine, Division of Infections Disease, Medical Research Institute, Pusan National University School of Medicine, Yangsan 50612, Korea;
| |
Collapse
|
37
|
Jang JW, Park JH, Kim S, Lee SH, Lee SH, Kim YJ. Prevalence and Incidence of Dementia in South Korea: A Nationwide Analysis of the National Health Insurance Service Senior Cohort. J Clin Neurol 2021; 17:249-256. [PMID: 33835746 PMCID: PMC8053535 DOI: 10.3988/jcn.2021.17.2.249] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Dementia is rapidly becoming more common in the elderly population of South Korea, and there are regional difference in its demographics. This study investigated the trajectories in the prevalence and incidence of dementia based on the Seoul metropolitan area and other areas in South Korea using big data from the National Health Insurance Service (NHIS). METHODS We examined a population-based elderly cohort obtained from the NHIS Senior Cohort (NHIS-SC) data set that comprises approximately half a million recipients of medical insurance in South Korea during 2003-2015. The age-standardized prevalence and incidence of dementia as well as their trajectories from 2003 were estimated. Regional differences in these rates between Seoul metropolitan area and other areas were also analyzed. RESULTS The standardized prevalence of dementia per 100,000 increased significantly from 178.11 in 2003 to 5,319.01 in 2015 (p<0.001). The standardized prevalence of dementia was higher in other areas than in Seoul metropolitan area. The standardized incidence of dementia per 100,000 person-years also increased significantly, from 126.41 in 2003 to 2,218.25 in 2015 (p<0.001). The standardized incidence of dementia was similarly higher in other areas than in Seoul metropolitan area (p<0.001). CONCLUSIONS This study has shown that the standardized prevalence and incidence of dementia increased steadily from 2003 to 2015 in South Korea based on the NHIS-SC data set, and differed between Seoul metropolitan area and other areas.
Collapse
Affiliation(s)
- Jae Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Jeong Hoon Park
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Seongheon Kim
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Seung Hwan Lee
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Suk Hee Lee
- Department of Statistics, Kangwon National University, Chuncheon, Korea
| | - Young Ju Kim
- Department of Statistics, Kangwon National University, Chuncheon, Korea.
| |
Collapse
|
38
|
Kim H, Kwon S. A decade of public long-term care insurance in South Korea: Policy lessons for aging countries. Health Policy 2020; 125:22-26. [PMID: 33189411 DOI: 10.1016/j.healthpol.2020.11.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/07/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
South Korea proactively introduced public long-term care insurance (LTCI) in 2008 when older people were only about one-tenth of the total population. At that time, Korea switched from a tax-based, local-government-operated LTC program targeting low-income older people to the current universal public LTCI run by the National Health Insurance Service, the single public insurer. The LTCI program provides a comprehensive package of home- and institution-based care mainly targeting older people who need assistance in daily living. Over the past decade, the program has continued to expand its population and service coverage: older people in high need have been covered, and an infrastructure for service provision has been established. Future agendas include financial sustainability, care coordination, and the role of local governments. Korea's experiences suggest having an LTCI separate from the NHI has the benefit of potential de-medicalization of LTC, which, in turn, creates challenges for the coordination of health care and LTC. A centralized LTCI system with a single payer has the benefit of bigger risk-pooling, but this may become a barrier to designing integrated community care systems at the local level. There is a tradeoff between population coverage, benefits/cost coverage, and fiscal sustainability.
Collapse
Affiliation(s)
- Hongsoo Kim
- Graduate School of Public Health Dept. of Public Health Sciences, Institute of Aging, Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, South Korea.
| | - Soonman Kwon
- Div. of Health Care Management and Policy, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, South Korea.
| |
Collapse
|
39
|
Lee C, Yang Q, Im EO, McConnell ES, Jung SH, Kim H. A 10-year trend in income disparity of cardiovascular health among older adults in South Korea. SSM Popul Health 2020; 12:100682. [PMID: 33134476 PMCID: PMC7589532 DOI: 10.1016/j.ssmph.2020.100682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/11/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives Although cardiovascular disease (CVD) risk has lessened in Korea, it is unclear whether older adults in all socioeconomic strata have benefited equally. This study explored trends in income disparities in CVD risk among older adults in Korea. Methods This was a secondary analysis of Korean National Health and Nutrition Examination Survey data (2008–2017), targeting 14,836 older adults (≥65 years). Socioeconomic position, defined as income and use of welfare benefits, was the primary indicator. The outcome was binary for predicted CVD risk (<90th vs. ≥ 90th). The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were used to assess trends in disparities. Results The percentage of older adults with a predicted CVD risk of 90% or more declined over time, but this was due to a decrease among the more affluent. Disparities have persisted since 2012, with a worsening trend seen for Medicaid recipients. We found significant absolute and relative disparities among men over 75 years of age in recent years (SII > 0.19, RII > 7). Conclusions These results may inform and improve policies regarding income disparity reduction and cardiovascular health. Income disparities in CVD risk have persisted since 2012, with a worsening trend seen for Medicaid recipients. Our results highlight the need to improve CVD risk management services offered to the economically disadvantaged. It is important to consider both the absolute and relative terms when examining the disparity trends.
Collapse
Key Words
- CVD, cardiovascular disease
- Cardiovascular health
- GLM, generalized linear model
- Income
- KCDC, Korean centers for disease control and prevention
- KNHANES, Korean national health and nutrition examination survey
- KNHI, Korean national health insurance
- Korea
- MAR, missing at random
- OECD, organization for economic cooperation and development
- Older adults
- RD, risk difference
- RII, relative index of inequality
- RR, relative risk
- SEP, socioeconomic position
- SII, slope index of inequality
- Trends
Collapse
Affiliation(s)
- Chiyoung Lee
- University of Washington Bothell School of Nursing & Health Studies, Bothell, WA, USA
| | - Qing Yang
- Duke University School of Nursing, Durham, NC, USA
| | - Eun-Ok Im
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Eleanor Schildwachter McConnell
- Duke University School of Nursing, Durham, NC, USA.,Duke Center for the Study of Aging and Human Development, Durham, NC, USA.,Department of Veterans Affairs Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC, USA
| | - Sin-Ho Jung
- Duke University School of Medicine, Durham, NC, USA
| | - Hyeoneui Kim
- Duke University School of Nursing, Durham, NC, USA
| |
Collapse
|
40
|
Kojima T, Mizokami F, Akishita M. Geriatric management of older patients with multimorbidity. Geriatr Gerontol Int 2020; 20:1105-1111. [PMID: 33084212 DOI: 10.1111/ggi.14065] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 01/08/2023]
Abstract
Older patients tend to have multimorbidity represented by multiple chronic diseases or geriatric conditions due to aging changes of organs, which require a variety of medical management. Currently, there are no sufficient disease treatment guidelines for older people with multimorbidity, therefore physicians have difficulty managing multimorbidity, such as which diseases should be treated intensively or to what extent the conditions should be improved. Furthermore, there are other points to be considered when initiating the treatment of diseases. For example, physicians must assess physical function. Some people have no difficulty with ambulation, but some are bedridden and have difficulty getting up on their own. As there are differences in disease severity, comorbid conditions and life expectancy, there should be differences in deciding treatment and prescribing drugs. It may be necessary to change the option for treatment depending on cognitive function, the living environment and the care environment, using comprehensive geriatric assessments. In addition, when treating multimorbidity, patients tend to have polypharmacy, which is a risk for adverse drug events. Because of this, it is necessary to consider dose reduction and drug discontinuation in patients with polypharmacy. Because of the global increase in older patients with multimorbidity, developing an essential method for managing multimorbidity is an urgent issue. More research and practices are necessary to achieve high-quality care in patients with multimorbidity. Geriatr Gerontol Int 2020; 20: 1105-1111.
Collapse
Affiliation(s)
- Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Fumihiro Mizokami
- Department of Pharmacy, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
41
|
Du P, Dong T, Ji J. Current Status of the Long-term Care Security System for Older Adults in China. Res Aging 2020; 43:136-146. [PMID: 32873142 DOI: 10.1177/0164027520949117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In response to the increasing care demand of older adults and their families, the construction of the long-term care (LTC) security system has been widely recognized by the government, society and families. This article discusses the socio-demographic background, current situation, achievements and issues of this system. The LTC security system in China has achieved considerable progress in enriched service provision and expanded social insurance system pilot programs. However, the issues of unbalanced service provision and the explorative design of the insurance system still need to be resolved. Our recommendations for the development of the LTC security system include comprehensively reviewing the integrated care service system in terms of placing "old adults at the center," addressing the long-standing divisions between urban and rural areas in service provision and insurance design, advancing research and discussion concerning pilot experiences and improving the unified evaluation and financial planning systems.
Collapse
Affiliation(s)
- Peng Du
- Development Studies Center, 12471Renmin University of China, Beijing, China
| | - Tingyue Dong
- Beijing Administration Institute, Beijing, China
| | - Jingyao Ji
- Institute of Social Development, 309677Chinese Academy of Macroeconomic Research, Beijing, China
| |
Collapse
|
42
|
Song M, Song H. Disagreement between a public insurer’s recommendation and beneficiary’s choice of long-term care services in Korea. Health Policy 2020; 124:881-887. [DOI: 10.1016/j.healthpol.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 03/25/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
|
43
|
Affiliation(s)
- Soyoon Weon
- The Korean Ministry of Health and Welfare , Sejong City, South Korea
- Centre for Research on Children and Families, School of Social Work, McGill University , Montreal, QC, Canada
| |
Collapse
|
44
|
Jung M, Ko W, Muhwava W, Choi Y, Kim H, Park YS, Jambere GB, Cho Y. Mind the gaps: age and cause specific mortality and life expectancy in the older population of South Korea and Japan. BMC Public Health 2020; 20:819. [PMID: 32487053 PMCID: PMC7268756 DOI: 10.1186/s12889-020-08978-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent life expectancy gains in high-income Asia-pacific countries have been largely the result of postponement of death from non-communicable diseases in old age, causing rapid demographic ageing. This study compared and quantified age- and cause-specific contributions to changes in old-age life expectancy in two high-income Asia-pacific countries with ageing populations, South Korea and Japan. METHODS This study used Pollard's actuarial method of decomposing life expectancy to compare age- and cause-specific contributions to changes in old-age life expectancy between South Korea and Japan during 1997 and 2017. RESULTS South Korea experienced rapid population ageing, and the gaps in life expectancy at 60 years old between South Korea and Japan were reduced by 2.47 years during 1997 and 2017. Decomposition analysis showed that mortality reductions from non-communicable diseases in South Korea were the leading causes of death contributing to the decreased gaps in old-age life expectancy between the two countries. More specifically, mortality reductions from cardiovascular diseases (stroke, ischaemic and hypertensive heart disease) and cancers (stomach, liver, lung, pancreatic cancers) in South Korea contributed to the decreased gap by 1.34 and 0.41 years, respectively. However, increased mortality from Alzheimer and dementia, lower respiratory tract disease, self-harm and falls in South Korea widened the gaps by 0.41 years. CONCLUSIONS Age- and cause- specific contributions to changes in old-age life expectancy can differ between high-income Asia-pacific countries. Although the gaps in old-age life expectancy between high-income Asia-pacific countries are primarily attributed to mortality changes in non-communicable diseases, these countries should also identify potential emerging threats of communicable diseases and injuries along with demographic ageing in pursuit of healthy life years in old age.
Collapse
Affiliation(s)
- Myunggu Jung
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Woorim Ko
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - William Muhwava
- African Centre for Statistics, United Nations Economic Commission for Africa, Addis Ababa, Ethiopia
| | - Yeohee Choi
- Department of Social Welfare, Graduate School of Social Welfare, Ewha Womans University, Seoul, South Korea
| | - Hanna Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Young Su Park
- Department of Anthropology, University College London, London, UK
| | | | - Youngtae Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea.
| |
Collapse
|
45
|
Han SJ, Jung HW, Oh DY, Lee JH, Moon SD, Lee S, Yoon JH. Comparisons of Clinical Outcomes between Weekday-Only and Full-Time, 24-Hour/7-Day Coverage Hospitalist Systems. J Korean Med Sci 2020; 35:e117. [PMID: 32383363 PMCID: PMC7211511 DOI: 10.3346/jkms.2020.35.e117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/27/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Since the launch of pilot programs in 2016, varying ranges of hospitalist coverage exist in Korea. We evaluated the effects of differing depths of hospitalist coverage on clinical outcomes. METHODS This study retrospectively reviewed the records of 513 patients admitted to a medical hospitalist unit through emergency department at Seoul National University Hospital. The full-time group included patients admitted in 2018 who received 24/7 hospitalist service, whereas the weekday group included patients admitted in 2019 with only weekday hospitalist service. In-hospital clinical outcomes were compared between the two groups. RESULTS Unplanned intensive care unit admission rate was lower in the full-time group than in the weekday group (0.4% vs. 2.9%; P = 0.042). Discharges to local hospitals for subacute or chronic care were more frequent in the full-time group than in the weekday group (12.6% vs. 5.8%; P = 0.007). The weekday coverage was a predictive factor of in-ward mortality (odds ratio, 2.00; 95% confidence interval, 1.01-3.99) after adjusting for potential confounding factors. CONCLUSION Uninterrupted weekend coverage hospitalist service is helpful for care-plan decision and timely care transitions for acutely and severely ill patients.
Collapse
Affiliation(s)
- Seung Jun Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hee Won Jung
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Do Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Do Moon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sunhye Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Hwan Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
46
|
Kim H, Jeon B. Developing a framework for performance assessment of the public long-term care system in Korea: methodological and policy lessons. Health Res Policy Syst 2020; 18:27. [PMID: 32087709 PMCID: PMC7036169 DOI: 10.1186/s12961-020-0529-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/21/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Limited evidence exists on how to assess long-term care system performance. This study aims to report on the process and results of developing a performance assessment framework to evaluate the long-term care system financed by the public long-term care insurance in South Korea. METHODS The framework was developed through a six-step approach, including setting the goals and scope of performance assessment in the given policy context, reviewing existing performance frameworks, developing a framework with a wide range of potential indicators, refining the framework through a series of Delphi surveys and expert meetings, examining the feasibility of generated indicators through a pilot test, receiving the comments of stakeholders, and finalising the performance framework. RESULTS The finalised framework has 4 domains - coverage, quality of care, quality of life and system sustainability - and 28 indicators, including 10 core indicators to monitor long-term care system performance. Usability and feasibility along with policy relevance were important criteria in selecting these indicators. The proposed framework can be used to assess the performance of the long-term care system in Korea, and the framework and its methodological approach can be benchmarks for other countries developing their own framework. CONCLUSIONS It is critical to reconcile and prioritise various stakeholders' views and information needs as well as to balance methodological rigor with practical usefulness and feasibility in the development and implementation of a long-term care performance monitoring system.
Collapse
Affiliation(s)
- Hongsoo Kim
- Graduate School of Public Health Dept. of Public Health Sciences, Institute of Aging, and Institute of Health and Environment, Seoul National University, Seoul, 151-742 Republic of Korea
| | - Boyoung Jeon
- National Rehabilitation Center, Seoul, 01022 Republic of Korea
| |
Collapse
|
47
|
Schulz M, Czwikla J, Tsiasioti C, Schwinger A, Gand D, Schmiemann G, Schmidt A, Wolf-Ostermann K, Kloep S, Heinze F, Rothgang H. Differences in medical specialist utilization among older people in need of long-term care - results from German health claims data. Int J Equity Health 2020; 19:22. [PMID: 32033606 PMCID: PMC7006141 DOI: 10.1186/s12939-020-1130-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. METHODS We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. RESULTS We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. CONCLUSION The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.
Collapse
Affiliation(s)
- Maike Schulz
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
| | - Jonas Czwikla
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
| | - Chrysanthi Tsiasioti
- Research Institute of the Local Health Care Funds (WIdO), P.O. Box 11 02 46, 10832 Berlin, Germany
| | - Antje Schwinger
- Research Institute of the Local Health Care Funds (WIdO), P.O. Box 11 02 46, 10832 Berlin, Germany
| | - Daniel Gand
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, Competence Center for Clinical Trials (KKSB), Linzer Straße 4, 28359 Bremen, Germany
| | - Guido Schmiemann
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, Competence Center for Clinical Trials (KKSB), Linzer Straße 4, 28359 Bremen, Germany
| | - Annika Schmidt
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, Competence Center for Clinical Trials (KKSB), Linzer Straße 4, 28359 Bremen, Germany
| | - Karin Wolf-Ostermann
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, Competence Center for Clinical Trials (KKSB), Linzer Straße 4, 28359 Bremen, Germany
| | - Stephan Kloep
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
- University of Bremen, High-Profile Area Health Sciences, Bremen, Germany
| | - Franziska Heinze
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
| | - Heinz Rothgang
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research (IPP), Grazer Straße 4, 28359 Bremen, Germany
| |
Collapse
|
48
|
Ganorkar S, Kabir ZN, Rustomfram N, Thakur H. Experiences of Older Persons in Seeking Care at a Private Hospital in Urban India. Gerontol Geriatr Med 2020; 6:2333721420910639. [PMID: 32284954 PMCID: PMC7139167 DOI: 10.1177/2333721420910639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/14/2020] [Accepted: 02/10/2020] [Indexed: 10/27/2022] Open
Abstract
Objective: The study aims to describe the experiences of older persons in seeking health care in a private hospital in urban India. Methods: Semi-structured interviews were conducted with 50 older persons admitted in or visiting a private hospital in Hyderabad city in India between the period November 2017 and April 2018. The data were analyzed using Content Analysis. Results: Dimensions related to payment mechanisms, quality of health care staff, and hospital quality were reported to be important for the older persons. Payment mechanisms were related to discounts, insurance support, and reducing out-of-pocket expenditure. Quality of care was related to optimizing hospital operational processes like discharge time, standard of treatment, and trustworthiness of the medical staff. Discussion: Payment mechanism can be made friendly for the older persons. Quality of hospital including its staff can be enhanced by developing geriatric-specific competencies which can help them to understand and treat complex health problems specific for the older population.
Collapse
Affiliation(s)
| | | | | | - Harshad Thakur
- Tata Institute of Social Sciences,
Mumbai, India
- National Institute of Health and Family
Welfare, New Delhi, India
| |
Collapse
|
49
|
Affiliation(s)
- Pablo Villalobos Dintrans
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
- Facultad de Ciencias Médicas, Programa Centro de Salud Pública, Universidad de Santiago, Chile
| |
Collapse
|
50
|
Zhu Y, Österle A. China's policy experimentation on long-term care insurance: Implications for access. Int J Health Plann Manage 2019; 34:e1661-e1674. [PMID: 31385373 DOI: 10.1002/hpm.2879] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/12/2022] Open
Abstract
China's population is aging rapidly, while the traditional long-term care (LTC) system that heavily relies on families is eroding. In response, China has embarked on a journey of policy experimentation for long-term care insurance (LTCI) since 2016, launching LTCI pilots in 15 pioneer cities. These pilots have a great diversity in participation, eligibility, and provision. This paper estimates the prevalence of LTC needs and analyzes the impact of the LTCI pilots on access. Although substantial progress has been achieved, the overall coverage of LTCI is still relatively small, and a large proportion of vulnerable people needing LTC seem to be left behind because of the strict eligibility criteria. This analysis suggests that future policy experimentation on LTCI reform in China needs to address the following pressing policy issues: expanding the coverage of LTCI; narrowing rural-urban disparities in access; improving access for vulnerable subpopulations; and reducing the heavy reliance on institutional care.
Collapse
Affiliation(s)
- Yumei Zhu
- Department of Socioeconomics, WU Vienna University of Economics and Business, Wien, Austria
| | - August Österle
- Department of Socioeconomics, WU Vienna University of Economics and Business, Wien, Austria
| |
Collapse
|