The impact of the expanded health insurance coverage policy on healthcare spending: evidence from Korea.

BACKGROUND: South Korea's National Health Insurance (NHI) system pursues universal health coverage, but it has not been able to alleviate patients' financial burden owing to limited coverage and a high proportion of out-of-pocket expenses. In 2017, the government announced a plan to strengthen universality by providing coverage for all unincluded services, expanding coverage, and alleviating household financial burden. We aimed to evaluate the effect of "Moon Care" with a focus on changes in health expenditures following policy implementation, and to provide empirical evidence for future policies to strengthen the NHI system's universality. METHODS: Using data from the 2016 and 2018 Korea Health Panel (KHP), we established a treatment group affected by the policy and an unaffected control group; we ensured homogeneity between the groups using propensity score matching (PSM). Subsequently, we examined changes in NHI payments, non-payments, and out-of-pocket payments (OOP); we performed difference-in-differences (DID) analysis to evaluate the policy's effect. RESULTS: Following policy implementation, the control group had a higher increase than the treatment group in all categories of health expenditures, including NHI payments, non-payments, and OOP. We noted significant decreases in all three categories of health expenditures when comparing the differences before and after policy implementation, as well as between the treatment and control groups. However, we witnessed a significant decrease in the interaction term, which confirms the policy's effect, but only for non-payments. CONCLUSIONS: We observed the policy's intervention effect over time as a decrease in non-payments, on the effectivity of remunerating covered medical services. However, the policy did not work for NHI payments and OOP, suggesting that it failed to control the creation of new non-covered services as noncovered services were converted into covered ones. Thus, it is crucial to discuss the financial spending of health insurance regarding the inclusion of non-covered services in the NHI benefits package.

Medical expenses and its determinants in female patients with urological disorder.

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.

Digital Health Care Industry Ecosystem: Network Analysis.

BACKGROUND: As the need for digital health care based on mobile devices is increasing, with the rapid development of digital technologies, especially in the face of the COVID-19 pandemic, gaining a better understanding of the industrial structure is needed to activate the use of digital health care. OBJECTIVE: The aim of this study was to suggest measures to revitalize the digital health care industry by deriving the stakeholders and major issues with respect to the ecosystem of the industry. METHODS: A total of 1822 newspaper articles were collected using Big Kings, a big data system for news, for a limited period from 2016 to August 2021, when the mobile health care project was promoted in Korea centered on public health centers. The R and NetMiner programs were used for network analysis. RESULTS: The Korean government and the Ministry of Health and Welfare showed the highest centrality and appeared as major stakeholders, and their common major issues were "reviewing the introduction of telemedicine," "concerns about bankruptcy of local clinics," and "building an integrated platform for precision medicine." In addition, the major stakeholders of medical institutions and companies were Seoul National University Hospital, Kangbuk Samsung Hospital, Ajou University Hospital, Samsung, and Vuno Inc. CONCLUSIONS: This analysis confirmed that the issues related to digital health care are largely composed of telemedicine, data, and health care business. For digital health care to develop as a national innovative growth engine and to be institutionalized, the development of a digital health care fee model that can improve the regulatory system and the cost-effectiveness of patient care, centering on the Ministry of Health and Welfare as a key stakeholder, is essential.

Full-face augmentation using Tissuefill mixed with platelet-rich plasma: "Q.O.Fill".

BACKGROUND: Hyaluronic acid fillers have become popular soft tissue filler augmentation agents over the past several years. Q.O.Fill (JW Pharmaceutical Co., Ltd., Seoul, Korea) is a newly developed soft tissue augmentation agent using Tissuefill (hyaluronic acid derivatives) mixed with platelet-rich plasma (PRP). The purposes of this study were to describe the Q.O.Fill method and evaluate the outcome of face augmentation. METHODS: A retrospective chart review was performed over a 2-year period. Seventy-five Asian participants with a mean age of 43.5 years were enrolled in the study. Mean total injection volume (baseline and touch-up) per participant was 8.9 mL. All participants underwent injection of Tissuefill mixed with PRP, Q.O.Fill. The results were evaluated using photographs and according to patients' satisfaction. RESULTS: Six months after the last injection, 100% of participants had improvement. At month 6, 97.3% of participants remained least improved over the baseline, and 90.7% felt much better or a little better until 2 years after the injection. The incidence of complications was low. CONCLUSIONS: The study showed that Q.O.Fill injection resulted in a very good aesthetic outcome and few adverse events. We believe that a facial augmentation with Tissuefill mixed with PRP is a safe and effective treatment method.

Subjective health status of multimorbidity: verifying the mediating effects of medical and assistive devices.

BACKGROUND: This study aimed to verify the mediating effect of using assistive devices as a factor that alleviates the relationship between multimorbidity and subjective health status. METHODS: This study used three-year data (2011-2013) from the Korea Health Panel (KHP). The data were jointly collected by the consortium of the National Health Insurance Service and Korea Institute for Health and Social Affairs. RESULTS: The mediating effect of using assistive devices was verified, but the direction of the effect was deteriorated subjective health. In other words, in terms of the impact of multimorbidity on subjective health, using assistive devices had a negative impact (-) on subjective health. CONCLUSIONS: The current assessment system for medical devices, narrow scope for choice of assistive devices, and limited scope of health insurance benefits must change to ultimately lead to a positive mediating effect on using medical devices and on subjective health satisfaction of patients with chronic diseases. A system that embraces all ages and generations must be developed. To this end, it is necessary to expand the scope of medical devices and insurance payment in long-term care insurance for elderly users, as well as the active meaning of medical devices in terms of health insurance.

Private health insurance and catastrophic health expenditures of households with cancer patients in South Korea.

This study examines the effects of private health insurance (PHI) on the incidence of catastrophic health expenditures (CHE) for households with a patient with cancer. This study uses 1-year data from 2013 and households with cancer patients as the unit of research rather than individual household members. The sample thus includes 468 households with members with cancer who also used emergency, outpatient and hospitalisation services. Households with PHI had a lower incidence of CHE for all thresholds than those without did. At the 10% threshold, the incidence became significantly lower, by 0.59 and 0.60 times, respectively, if householders had higher education and income levels. Moreover, the incidence of CHE was higher by 8.71 times if the householders are female, and lower by 0.84 times if the householders did not have a spouse at the 20% threshold. From the analysis of households with cancer patients that hold PHI as the key variable, these households showed a lower incidence of CHE than the others did. PHI provides healthcare payments not secured through national health insurance (NHI) and protects households from health expenditures, thereby complementing NHI to a certain degree.

Outcome of facial rejuvenation with polydioxanone thread for Asians.

BACKGROUND: Techniques in rejuvenating the aging face have evolved, involving various types of threads. Facial rejuvenation with absorbable polydioxanone is popular in aesthetic clinics in Korea. AIM: The purpose of this study was to describe our polydioxanone thread method and to evaluate the outcomes of facial rejuvenation. PATIENTS/METHODS: A retrospective chart review was performed over a 12-month period. Thirty-five Asian patients were included. All participants underwent thread-lifting using polydioxanone. On each side, five 360° spiral cog threads were used in the procedure. The results were evaluated using photography and patient satisfaction. RESULTS: Thirty-three patients (94.3%) were satisfied with the outcomes. Objective outcomes using photography were categorized as very much improved (68.6%), much improved (25.7%), and improved (5.7%). Subjective outcomes using patients' satisfaction were categorized as excellent, very good, good, fair, and poor. The incidence of complications was low, and the complications resolved spontaneously without any surgical interventions. Asymmetry, however, was noted. CONCLUSIONS: Using our technique, we could achieve the desired facial rejuvenation. Our method demonstrated an excellent success rate in patients with moderate degree laxity. We believe that facial rejuvenation with polydioxanone thread for Asians is a safe and effective treatment method.

Perception of Community on Attachment and Resilience According to Closing of Hospitals.

This study includes a comparison analysis of how community resilience and its influence factor of community attachment were changed before and after the closing of the hospital in the rural community. In order to analyze the influence factors of healthcare and medical vulnerability on community resilience, as well as the mean difference from before and after the closing of the hospital, this study conducted matching sample t test, hierarchical regression analysis, difference in differences (DID) analysis. The results indicate that community attachment consists of such factors as closeness, preference, affective bond, and identity, and they showed significance in confidence. It showed that resilience and community attachment are lower after closing than before closing. Moreover, as a result of DID analysis where the variation of community attachment affects community resilience, closeness together with closeness had an influence on the community resilience. It needs to expand public projects to improve the settlement environment of the basic local government, and in particular, it should consider various support measures to overcome vulnerabilities in the healthcare and medical sector.

Social Network Analysis in the Legislative Process in the Korean Medical Device Industry.

This study analyzes the legislation process of the Korean government regarding the development of the medical device industry in the perspective of the issue network. It also aims to identify the difference in network structure between conservative and progressive governments and analyze major issues and stakeholders. It examines the network structure in the legislation process of the government to develop and support the medical device industry through social network analysis (SNA). This study conducted a policy network structure analysis of the conservative and progressive governments. SNA was used for the structure analysis, using the contents of newspaper articles as the baseline data related to the medical device industry. We analyze using the 2-mode network analysis that the node centrality is determined by eigenvector centrality. The more nodes with great power (stakeholders, information, resources) it is linked to, the greater power centrality (eigenvector centrality) it will have, which indicates that it has great influence within the network. The conservative government discussed the promotion of the medical device industry led by government departments, focusing on its potential as a future growth engine. On the contrary, the progressive government tended to have fewer stakeholders and issues around the idea, shifting the stakeholders that lead the promotion of the industry from government departments to relevant interest groups, and focusing more on policy issues like transparency than on economic issues. We identify implications to legislate the relevant act by analyzing the relevant stakeholders and issues around legislation, while reinforcing the competitiveness of Korea's medical device industry in the larger global framework. We believe that this study would comprehensively addresses the pros and cons of the government-led promotion of the medical device industry in Korea, as well as the key issues for stakeholders, which can be applicable to many other societies.

Effectiveness of artificial intelligence in detecting and managing depressive disorders: Systematic review.

OBJECTIVES: This study underscores the importance of exploring AI's creative applications in treating depressive disorders to revolutionize mental health care. Through innovative integration of AI technologies, the research confirms their positive effects on preventing, diagnosing, and treating depression. The systematic review establishes an evidence base for AI in depression management, offering directions for effective interventions. METHODS: This systematic literature review investigates the effectiveness of AI in depression management by analyzing studies from January 1, 2017, to May 31, 2022. Utilizing search engines like IEEE Xplore, PubMed, and Web of Science, the review focused on keywords such as Depression/Mental Health, Machine Learning/Artificial Intelligence, and Prediction/Diagnosis. The analysis of 95 documents involved classification based on use, data type, and algorithm type. RESULTS: The study revealed that AI in depression management excelled in accuracy, particularly in monitoring and prediction. Biomarker-derived data demonstrated the highest accuracy, with the CNN algorithm proving most effective. The findings affirm the therapeutic benefits of AI, including treatment, detection, and disease prediction, highlighting its potential in analyzing monitored data for depression management. LIMITATIONS: This study exclusively examined the application of AI in individuals with depressive disorders. Interpretation should be cautious due to the limited scope of subjects to this specific population. CONCLUSIONS: To introduce digital healthcare and therapies for ongoing depression management, it's crucial to present empirical evidence on the medical fee payment system, safety, and efficacy. These findings support enhanced medical accessibility through digital healthcare, offering personalized disease management for patients seeking non-face-to-face treatment.

The state of arts and health in the Republic of Korea.

BACKGROUND: The field of arts and health has been growing rapidly in the Republic of Korea (ROK) as a means to solve social problems with the development of arts and health government programs to prevent mental disorders and improve quality of life. This study addresses the history, policy and funding scale, practices, and challenges of the arts and health in the ROK and provides a global overview of different countries to guide development procedures and communicate directions to relevant stakeholders. METHODS: Data were collected using various methods, including policy reports, grey literature, peer-reviewed articles, and open data provided by Statistics Korea. RESULTS: Progress has been made in identifying specific opportunities for the arts to address mental health concerns in the Korean society. Specialty and digital arts are emerging as new professional practices in the arts and health fields. CONCLUSIONS: Establishing new government agencies is the next challenge toward identifying and reaching a consensus among relevant stakeholders for the future development of arts and health in the ROK.

An analytic hierarchy process analysis for reinforcing doctor-patient communication.

BACKGROUND: As the health paradigm shifts toward patient-centeredness, patients can actively participate in their own treatment. However, there is still a unilateral aspect of doctor-patient communication, so it is necessary to specify obstacles between doctors and patients. Therefore, this study attempted to extract obstacles that block doctor-patient communication and to analyze differences in perception of doctor-patient communication. METHODS: A total of 35 questionnaires composed of brainstorming for the study were distributed, and a total of 21 questionnaires were used for analysis. The collected data was analyzed by AHP using dress ver 17.0. RESULTS: As a result of the study, doctors ranked the priority of health communication in the order of professionalism, reliability, fairness, communication, and psychologically. On the other hand, for patients, the priority factors of health communication were communication, fairness, professionalism, reliability, and psychologically. CONCLUSION: In order to improve the quality of health communication between doctors and patients, doctors will be able to communicate from the patient's point of view and strengthen communication with patients by providing consistent medical services and patients need to trust the doctor and patients need to trust their doctors and participate in the medical process faithfully.

Analyzing the Effectiveness of Data-Linked Projects for Health Promotion in Public Health Centers of South Korea.

Purpose: The purpose of this study lies in verifying the effectiveness of the health promotion project which the public health center at the local level conducted by systematically linking the health examination results from the Health Insurance Corporation. We intend to emphasize the importance of linking the health-related public data. Methods: A survey was conducted to measure the effect of improving health behavior using EQ-5D-5L and demographic variables. Results: As a result of the analysis, the residents (3.13) who had experienced the use of public health centers recognized more necessity for the service linked systematically with health checkup data than those (2.93) who had not. In addition, the residents who had experienced the use of public health centers responded that their chronic diseases had improved compared to a year ago (2.78→2.93). Next, those (3.04) who had experienced the services linked with health checkup data recognized that their chronic diseases and health conditions had been improved compared to those (2.81) who had not. However, in EQ-5D-5L, after using the service, mobility showed no difference between those who had used the service and those who had not. Furthermore, even in terms of self-management, daily life, etc., the management ability was further improved compared to those who had not used it, before using the service. Conclusion: This study showed the improved health level when the health promotion service of the public health center was provided by systematically linking the health checkup data of the Health Insurance Corporation in Korea. In order to increase the effectiveness of health data-linked projects, it is necessary to prepare guidelines for linking the public health data and to expand the data-linked project. It will be needed to further subdivide the health checkup results to provide customized services, and to secure dedicated personnel to reinforce the system link.

Strategic management and organizational culture of medical device companies in relation to corporate performance.

AIMS: Strategies focus on securing the competitiveness of medical device corporations by strengthening their organizational capabilities, which, in turn, ensure their continuous development. This study aims to investigate both management strategies and organizational culture, which may affect the performance of these companies, and analyzes the influence of education and training investment. MATERIALS AND METHODS: We used data from the 3rd to 6th Human Capital Corporate Panel surveys by the Korea Research Institute for Vocational Education and Training as well as data from the Korea Information Service and 6,112 workers and 260 companies were analyzed. For the analysis, management strategy and organizational culture were set as independent variables, and corporation performance was set as the dependent variable. Additionally, investment in education and training was set as a control variable between the independent and dependent variables. Corporate performance was analyzed by dividing into organizational satisfaction and organizational commitment. RESULTS: Differentiation strategy and innovative culture had a positive (+) effect on organizational satisfaction, while cost leadership strategy and hierarchical culture had a negative (-) effect. On the other hand, in the case of interaction with education and training investment, cost leadership strategy and hierarchical culture had a positive (+) effect, while differentiation strategy and innovation culture had a negative (-) effect. In organizational commitment, innovation culture had a positive (+) effect, and hierarchical culture had a negative (-) effect. In the case of interaction with investment in education and training, only the hierarchical culture had a positive (+) effect. CONCLUSIONS: The innovation culture positively influenced the performance of medical device companies. Furthermore, cost leadership strategy, hierarchical culture, education and training investment improved the corporate performance of these companies. To enhance corporate performance, these companies should create an innovation culture and invest in education and training in accordance with the organizational culture.

COVID-19 has proven the excellence of Korea's medical devices, and the medical device industry is expected to continue to grow due to the increase in chronic disease and non-face-to-face treatment. However, the current medical device industry is monopolized by global companies with capital and technological prowess. To overcome this, Korean medical device companies are developing innovative medical devices centered on start-ups, but now is the time to strategically respond to them in order to compete with global companies. In general, companies establish management strategies for survival and growth by analyzing threats and opportunities based on the market environment to maintain the optimal organization according to market competition, government policies, and changes in consumer needs. Strategies are often established based on the culture of the organizations that make up the company. When it comes to strategy establishment, the medical device industry has special characteristics compared to other industries. The medical device industry is based on advanced technology and puts patient safety first, requiring continuous product upgrades. Therefore, it is an essential industry for employees to invest in education and training. The analysis shows the effectiveness of investment in education and training according to the management strategy and organizational culture of medical device companies. It was confirmed that when medical device companies create an Innovation culture, their performance improves. It also shows that when medical device companies adopt a cost leadership strategy, they need to increase their investment in education and training to improve corporate performance.

Comparative Analysis of Factors Affecting Quality of Community-Based Care Services in Korea.

Aging societies have an increased need for care services. To solve the problem of care, we suggest community care, through which medical services are provided that meet individual needs. Korea provides care services in advance of the community care project and implements quality control to improve the quality of these social services. Therefore, this study aims to compare and analyze the factors affecting user satisfaction in care services in both 2013 and 2016. We analyzed secondary data from 2013 and 2016 collected by the Social Security Information Service. These data include standardized metrics for the quality of care. Based on the evaluation indexes for care service in 2013 and 2016, we used commonly used indexes for analysis. Specifically, non-profit organizations were influenced by sales, accounting management, lifetime tenure rate, etc., while for-profit organizations were affected by number of users, contract termination, etc. In addition, on-site evaluation had a negative effect on the change rate of user satisfaction. Therefore, in order to increase satisfaction with care services, evaluation indexes by service type should be diversified and differentiated. In addition, field evaluations related to user satisfaction should be performed in order to provide care services appropriate for local characteristics.

Factors influencing the health satisfaction of users of public health and medical institutions in South Korea.

Introduction: In this study, we investigated the health satisfaction levels of users of regional health and medical institutions in South Korea and the influencing factors. Methods: We included randomly selected 300 people with experience in using health and medical institutions from panel data targeting the entire nation. We used questionnaire (EQ-5D-5L) and sociodemographic characteristics to analyze the health satisfaction. EQ-5D-5L was used to measure health-related quality of life in five areas: mobility, self-management, daily activities, pain/discomfort, and anxiety/depression. Hierarchical linear regression analysis was performed in three steps to examine the factors influencing health satisfaction. Results: The analysis showed that the health satisfaction was positively (+) correlated with monthly income, mobility, self-management, daily life, pain/discomfort, and anxiety/depression, and negatively (-) correlated with the number of chronic diseases and type of health insurance. The influencing factors in Step 1 and 2 were chronic diseases (ß = -0.380, -0.385), respectively. The influencing factors in Step 3 were pain/discomfort (ß = 0.202), anxiety/depression (ß = 0.257), and the number of chronic diseases (ß = -0.222). Discussions: The current data suggested that regional health and medical institutions should focus their services on residents with chronic diseases. Moreover, they should expand physical activities to relieve physical pain or discomfort and provide services related to mental health. To accomplish these, we suggested that the government will need to promote post-service health checkup results as a key project, provide user-customized services, provide online services utilizing ICT, expanding the government's financial support, and building infrastructure.

How to calculate the life cycle of high-risk medical devices for patient safety.

In this study, we analyzed Korean and foreign systems, focusing on high-risk medical devices that urgently need to be managed, and we present an life cycle calculation method for determining replacement time. A literature review was conducted to confirm the regulations of the medical device management system and life cycle by country, and a case analysis was performed to verify the replacement evaluation criteria of actual medical institutions. In addition, durability data from the Public Procurement Service, American Hospital Association, and Samsung Medical Center were used to calculate the life cycle of high-risk medical devices. The analysis showed that in the case of Korean and foreign medical device regulatory agencies, there were no specific life cycle regulations for high-risk medical devices. In addition, the important items in the medical device replacement evaluation were found to be the year of introduction, repair cost, component discontinuation, and several failures. On calculating the life cycle of high-risk medical devices revealed that the replacement time is 13 years for anesthesia machines, 14 years for defibrillators, 16 years for heart-lung machines, and 13 years for ventilators. To introduce a uniform medical device replacement standard and life cycle calculation method, the government will need to reorganize the medical device replacement laws and systems. In addition, in the case of medical institutions, it is necessary to secure patient safety by using expert groups to prepare specific life cycle standards that consider the characteristics of medical devices.

Factors associated with quality of life in patients with benign prostatic hyperplasia, 2009-2016.

This study analyzed the factors affecting the health-related quality of life of patients with benign prostatic hyperplasia (BPH) according to age. We also aimed to determine appropriate strategies to improve their quality of life. Data from the Korea Health Panel Survey (2009-2016) were used in this study. A total of 3806 patients with BPH were divided into 2 groups: younger adults (aged under 65 years) and older adults (aged over 65 years). In addition, a logistic regression analysis was conducted to identify factors affecting the quality of life of young and older patients with BPH. In younger adult patients with BPH, the higher the level of education, the higher the quality of life by a factor of 1.379, and the more intense the physical activity, the lower the quality of life by a factor of 0.791. Also, the longer the sitting time, the lower the quality of life by a factor of 0.765. In contrast, for older adult patients with BPH, the quality of life improved by factors of 1.601 and 2.921, respectively, for health insurance and higher income level. In addition, it was found that the quality of life decreased by a factor of 0.754 in patients who drink alcohol. In order to improve the quality of life of the middle-aged adult population with BPH, it is necessary to reduce sitting time through constant physical activity. Moreover, the cost of medical care should be reduced and the quality of life increased through reductions in surgical treatment, as the burden of medical expenses will degrade the quality of life for older adults.

The usefulness of patient-specific 3D nasal silicone implant using 3D design and order form.

PURPOSE: The need for customized implants has continuously increased, but patient-specific silicone implants are not yet commonly used in the plastic surgery market. We sought to validate the effectiveness of a 3D customized nasal implant design in terms of design and lead time compared with a manually customized implant by a surgeon. MATERIALS AND METHODS: Based on the computed tomography (CT) findings of 15 patients who planned rhinoplasty, a surgeon wrote order forms reflecting the surgical plan and subsequently designed implants manually using epoxy on a 3D printed skull. Separately, engineers analyzed the CT findings and designed 3D implants based on the order forms. RESULTS: Epoxy designs were 3D-scanned, converted into a stereolithography format and compared with 3D implant designs to assess which method had a smaller margin of error as per the preoperative order form. Moreover, the lead time in all steps are compared. Nasion thickness, tip thickness, glabella starting point, glabella width, radix width, and total volume were comparatively analyzed. In all parameters, the error rate of the 3D design is relatively lower than that of the epoxy design. The former also had a lower total volume and a faster manufacturing time. CONCLUSION: With novel 3D customized nasal implants, the limitations of ready-made silicone implants are addressed, and it is now possible to preoperatively design implants more accurately, quickly, and conveniently.