Effects of a Medical Aid program on medical utilization patterns for low-income patients with affective disorder in Seoul.

ABSTRACT: Mental illness has been increasing globally and its global burden of disease has reached a significant level, and urban dwellers have more chances of having worse mental health status due to high population density, isolated social networks. In Korea's medical security system, Medical Aid (MA) program and National Health Insurance (NHI), patients covered by MA pay much smaller out-of-pocket payments for outpatient services because of exempt from hospitalization fees. However, as a result of focusing on improving access to medical services for the urban poor due to lower out-of-pocket payment, their healthcare costs have greatly increased, while their health management has thus far been inadequate. In light of the background, this study investigated the differences in patterns of medical utilization among affective disordered patients covered by the MA program and the NHI system respectively.Data used for this study were extracted from customized health information data from the National Health Insurance Service (NHIS). The data source used in this study, customized claims data from the NHIS, is census data, which strengthens the representativeness and reliability of the study results. A total of 6754 inpatients (MA: 3327 and NHI 20%: 3327) diagnosed with the affective disorder were retrieved by Propensity Scores Matching (PSM).The length of stay of MA beneficiaries was found to be longer than that of NHI enrollees. However, the rate of hospital emergency room visits by NHI enrollees was higher than that of MA beneficiaries.Overall, community-based interventions are required to prevent and treat mental health by providing primary medical care in the community, and linking with mental health centers. Such policies will ultimately improve the financial sustainability of medical security systems.

Convenience Store Use and the Health of Urban Adolescents in Seoul, South Korea.

To improve urban adolescents' dietary behaviors and health, factors that influence them to buy meals in convenience stores with regard to urban food environments must be determined. This study investigated the factors which influence adolescents' substitution of meals with convenience store meals and its impact on their health in Seoul (South Korea). Multilevel analysis and logistic regression analysis were conducted using data from the Korea Youth Risk Behavior Survey, a national health survey with a representative sample of Korean adolescents. Among 17,624 teenagers who responded to surveys in 2017 and 2019, 30.5% of them substituted meals with convenience store meals more than three times a week. Girls and students with a lower family economic level were more likely to frequently consume food from convenience stores. Unhealthy lifestyles and poor mental health status also influenced their decisions to substitute meals with convenience store food. Those who frequently consumed meals from convenience stores were more likely to have unhealthy lifestyles, featuring bad diets, smoking, drinking, and sedentary behaviors. They also reported significantly poorer self-rated health and mental health. To promote healthy lifestyles among adolescents, efforts to raise awareness and develop supportive environments for healthy diets are strongly recommended.

The Effects of Health Coverage Schemes on Length of Stay and Preventable Hospitalization in Seoul.

The Medical Aid program is government’s medical benefit program to secure the minimum livelihood and medical services for low-income Korean households. In Seoul, the number of Medical Aid beneficiaries has grown, driving an increases in the length of stay (LOS) and healthcare cost. Until now, studies have focused on quantity indicators, such as LOS, but only a few studies have been conducted on the service quality. We investigated both LOS and the preventable hospitalization (PH) rate as proxy indicators for the quantity and quality of services provided to Medical Aid beneficiaries in Seoul. To understand the program’s impact, we extracted appropriate data of Medical Aid beneficiaries and data of the lower 20% of National Health Insurance (NHI) enrollees, performed Propensity Score Matching (PSM), and controlled the variables related to disease severity. The differences between Medical Aid beneficiaries and NHI enrollees were estimated using multilevel analysis. The LOS of Medical Aid beneficiaries was longer, and the preventable hospitalization (PH) rate was higher than that of NHI enrollees. It implies that these beneficiaries did not receive timely and adequate healthcare services, despite their high rate of service utilization. Thus, indicators such as patient’s visits and screening related to PHs should be included in management policies to improve primary care.

The Relationship between Obesity and Urban Environment in Seoul.

Obesity is a global pandemic that brings about a myriad of health consequences. In the past, policies for combating obesity mainly focused on improving individual health and behavior, but nowadays some policies have changed and now concentrate on improving the built environment believing this can improve health through positive changes to health-related behaviors. We examined whether both individual and environmental factors were associated with body mass index in Seoul, the capital city of South Korea. Data from the 2011 and 2013 Community Health Surveys were used (n = 20,147 men and 25,300 women). We staged multilevel logistic regression models to estimate the effect of individual and environmental factors on obesity. Among individual covariates, high-risk drinking, the time spent watching TV and surfing the Internet, high salt intake, stress, and the negative recognition of health were significantly associated with obesity. When controlling individual covariates, the number of sports facilities, number of fried chicken stores, and food insecurity level were statistically associated with probability of obesity. Therefore, this study emphasizes that it is important not only to improve the health behavior of the individual, but also to improve the urban environment in order to reduce the obesity rates of city dwellers.

Relationship between socioeconomic status and type 2 diabetes: results from Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012.

OBJECTIVE: To examine the relationship between socioeconomic status (SES) and type 2 diabetes using the Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012. DESIGN: A pooled sample cross-sectional study. SETTING: A nationally representative population survey data. PARTICIPANTS: A total of 14,330 individuals who participated in the KNHANES 2010-2012 were included in our analysis. PRIMARY OUTCOME: Prevalence of type 2 diabetes. RESULTS: The relationship between SES and type 2 diabetes was assessed using logistic regression after adjusting for covariates including age, gender, marital status, region, body mass index, physical activity, smoking and high-risk drinking behaviour. After adjustment for covariates, our results indicated that individuals with the lowest income were more likely to have type 2 diabetes than those with the highest income (OR 1.35; 95% CI 1.08 to 1.72). In addition, lower educational attainment was an independent factor for a higher prevalence of type 2 diabetes in Korea. CONCLUSIONS: These findings suggest the need for developing a health policy to ameliorate socioeconomic inequalities, in particular income and education-related disparities in type 2 diabetes, along with risk factors at the individual level. In addition, future investigations of type 2 diabetes among Koreans should pay more attention to the social determinants of diabetes in order to understand the various causes of the condition.