Association between nurse staffing level in intensive care settings and hospital-acquired pneumonia among surgery patients: result from the Korea National Health Insurance cohort.

This study examined the association between the number of nursing staff in intensive care units (ICUs) and hospital-acquired pneumonia (HAP) among surgical patients in South Korea. Data were obtained between 2008 and 2019 from the Korean National Health Insurance Service Cohort Database; 37,706 surgical patients who received critical care services were included in the analysis. Patients with a history of pneumonia 1 year prior to surgery or those who had undergone lung-related surgery were excluded. The ICU nursing management fee is an admission fee that varies based on the grading determined by nurse-to-bed ratio. Using this grading system, we classified four groups from the highest to the lowest level based on the proportion of beds to nurses (high, high-mid, mid-low, and low group). HAP was defined by the International Classification of Disease, 10th revision (ICD-10) code. Multilevel logistic regression was used to investigate the relationship between the level of ICU nurse staffing and pneumonia, controlling for variables at the individual and hospital levels. Lower levels of nurse staffing were associated with a greater incidence of HAP than higher levels of nurse staffing (mid-high, OR: 1.33, 95% CI: 1.12-1.57; mid-low, OR: 1.61, 95% CI: 1.27-2.04; low, OR: 2.13, 95% CI: 1.67-2.71). The intraclass correlation coefficient value was 0.177, and 17.7% of the variability in HAP was accounted for by the hospital. Higher ICU nursing management fee grades (grade 5 and above) in general and hospital settings were significantly associated with an increased risk of HAP compared to grade 1 admissions. Similarly, in tertiary hospitals, grade 2 and higher ICU nursing management fees were significantly associated with an increased risk of HAP compared to grade 1 admissions. Especially, a lower level of nurse staffing was associated with bacterial pneumonia but not pneumonia due to aspiration. In conclusion, this study found an association between the level of ICU nurse staffing and HAP among surgical patients. A lower level of nurse staffing in the ICU was associated with increased rates of HAP among surgical patients. This indicates that having fewer beds assigned to nurses in the ICU setting is a significant factor in preventing HAP, regardless of the size of the hospital.

Trends in private caregiving cost after implementing a comprehensive nursing service covered by national health insurance: Interrupted time series.

BACKGROUND: The Korean government has implemented a comprehensive nursing care service system (CNS) to mitigate the stress faced by caregivers. OBJECTIVE: This study aimed to assess trends in the estimated average costs of private caregiving and determine the difference in costs between those using CNS and those not using it. DESIGN: A comparative interrupted time series analysis with a 2-year lag period verified total private caregiving cost trends; biannual differences in costs were evaluated based on using CNS. PARTICIPANTS: The main unit of analysis was episode. We extracted a total of 6418 episodes of hospitalization in acute care settings that included the use of caregiving services (formal, informal caregiving and CNS). METHODS: We conducted segmented regression to assess the impact of CNS on total private caregiving costs using data from 2012 to 2018, excluding the years 2015 and 2016 of the Korean Health Panel dataset. RESULTS: We presented that the immediate mean difference in total private caregiving costs between CNS users and non-users was -444.7 USD two years after the implementation of the CNS policy (95 % CI -714.5 to -174.5, p-value 0.001). Among individuals living in rural areas, two years after the implementation of the CNS policy, there was a significant immediate mean cost difference of -476.9 USD in total private caregiving costs between CNS users and non-users (p-value 0.011). Similarly, for episodes with a Charlson Comorbidity Index (CCI) score of 0 to 1, there was a substantial immediate mean cost difference in total private caregiving costs between CNS users and non-users, amounting to -399.9 USD two years after the CNS policy (p-value 0.008). CONCLUSIONS: This study evaluated the trend of total private caregiving costs between groups using and not using CNS. After two years of being covered by CNS health insurance, those who utilized CNS paid $433 less for their total private caregiving cost over a 6-month period, compared to those who did not use CNS. The adoption of CNS may be an effective system for relieving the financial burden on inpatients in need of private caregiving services. TWEETABLE ABSTRACT: Korean Comprehensive Nursing Service reduces private caregiving costs.

Socioeconomic Status and Dementia Risk Among Intensive Care Unit Survivors: Using National Health Insurance Cohort in Korea.

BACKGROUND: In aging populations, more elderly patients are going to the intensive care unit (ICU) and surviving. However, the specific factors influencing the occurrence of post-intensive care syndrome in the elderly remain uncertain. OBJECTIVE: To investigate the association between socioeconomic status (SES) and risk of developing dementia within two years following critical care. METHODS: This study included participants from the Korean National Health Insurance Service Cohort Database who had not been diagnosed with dementia and had been hospitalized in the ICU from 2003 to 2019. Dementia was determined using specific diagnostic codes (G30, G31) and prescription of certain medications (rivastigmine, galantamine, memantine, or donepezil). SES was categorized into low (medical aid beneficiaries) and non-low (National Health Insurance) groups. Through a 1:3 propensity score matching based on sex, age, Charlson comorbidity index, and primary diagnosis, the study included 16,780 patients. We used Cox proportional hazard models to estimate adjusted hazard ratios (HR) of dementia. RESULTS: Patients with low SES were higher risk of developing dementia within 2 years after receiving critical care than those who were in non-low SES (HR: 1.23, 95% CI: 1.04-1.46). Specifically, patients with low SES and those in the high-income group exhibited the highest incidence rates of developing dementia within two years after receiving critical care, with rates of 3.61 (95% CI: 3.13-4.17) for low SES and 2.58 (95% CI: 2.20-3.03) for high income, respectively. CONCLUSIONS: After discharge from critical care, compared to the non-low SES group, the low SES group was associated with an increased risk of developing dementia.

Chronic alcoholism and all-cause mortality among disabled individuals: Findings from the Korea National Health Insurance Service-National Sample Cohort.

BACKGROUND: Alcohol use among adults with mild to severe disability is an under-researched topic in the literature. Few studies have attempted to assess the impact of alcohol misuse, abuse, and chronic alcoholism among this target group. Thus, we investigated the association between chronic alcoholism and mortality among disabled individuals in South Korea. METHODS: We used data from the National Health Insurance Service National Sample Cohort (NHIS-NSC) for the years 2003-2013, which included data on 61,013 disabled individuals. Among these patients, a multivariate Cox proportional hazards model was used to estimate the hazard ratio of mortality associated with chronic alcoholism. RESULTS: A total of 800 individuals died during the study period. Individuals who had medical claims for chronic alcoholism following their disability diagnosis had greater risk of mortality than individuals without chronic alcoholism (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.06-2.31, p = 0.0244). Individuals with a physical disability (HR: 2.30, 95% CI: 1.06-4.95, p = 0.0342), brain lesion (HR: 1.96, 95% CI: 1.03-3.74, p = 0.0405), and/or kidney failure (HR: 4.98, 95% CI: 1.07-23.25, p = 0.0411) had greatest mortality risk when diagnosed with chronic alcoholism, compared to individuals who were not diagnosed with chronic alcoholism. CONCLUSIONS: Chronic alcoholism following disability diagnosis was associated with greater mortality risk in a nationally representative population of disabled individuals, especially among individuals with a physical disability, brain lesion, and/or kidney failure. Such findings reveal that certain social and political measures must be implemented to help disabled individuals suffering from alcoholism, especially according to disability diagnosis.

Association between Continuity of Care and the Onset of Thyroid Disorder among Diabetes Patients in Korea.

Objectives: As the relationship between diabetes mellitus and thyroid dysfunction is well known, it is important to investigate the factors influencing this association. Continuity of care is associated with better quality of care and outcomes, such as reduced complications, among diabetes patients. Therefore, the purpose of this study was to investigate the association between continuity of care and the onset of thyroid dysfunction among diabetes patients. Methods: We used Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013. Our final study population included 16,806 newly diagnosed diabetes patients who were older than 45 years of age. Continuity of care was measured using the Continuity of Care index. The dependent variable was the onset of thyroid disorder. Cox proportional hazard regression models were used for statistical analyses. Results: Diabetes patients with low continuity of care were at increased risk of the onset of thyroid disorder compared with those with high continuity of care (hazard ratio (HR): 1.28, 95% confidence interval (CI): 1.07⁻1.54). Subgroup analyses showed that this association was significant within patients with type 2 diabetes (HR: 1.24, 95% CI: 1.01⁻1.52) or whose main attending site was a local clinic (HR: 1.32, 95% CI: 1.07⁻1.64). Conclusions: Our results show that diabetes patients with low continuity of care are more likely to experience the onset of thyroid disorder. Therefore, improving continuity of care could be a reasonable method of preventing complications or comorbidities, including thyroid disorder, among diabetes patients.

Do cost containment policies save money and influence physicians' prescribing behavior? Lessons from South Korea's drug policy for diabetes medication.

OBJECTIVE: We evaluate the effects of drug price reduction policy on pharmaceutical expenditure and prescription patterns in diabetes medication. DESIGN: An interrupted time series study design using generalized estimating equations. SETTING: This study used National Health Insurance claim data from 2010 to 2013. PARTICIPANTS: A total of 68 127 diabetes patients and 12 465 hospitals. INTERVENTION(S): The drug price reduction policy. MAIN OUTCOME MEASURES: The primary outcome is pharmaceutical expenditure and prescription rate. To evaluate changes in prescription rate, we measured prescription rates such a brand-name drug and drug price reduction rate. RESULTS: Although the drug price reduction policy associated with decreased pharmaceutical expenditure (-13.22%, P < 0.0001), the trend (-0.01%, P = 0.9201) did not change significantly compared with the pre-intervention period. In addition, the trends in the monthly prescription rate of brand-name drugs decreased (-0.14%, P = 0.0091), while the immediate change was an increase (5.72%, P < 0.0001). Regardless of the drug reduction rate, the prescription rate after the introduction of the drug price reduction policy decreased compared with the pre-intervention period, and this decline was significant for reduction rates of 0% (-2.74%, P < 0.0001) and 10% (-0.13%, P = 0.0018). CONCLUSIONS: Our results provide evidence of the effects of the drug price reduction policy on pharmaceutical expenditure and prescription patterns. This policy did not affect the prescribing behavior of healthcare providers and did not increase the use of drugs not subject to this policy. Although this study did not observe changes in the cost of pharmaceuticals after the introduction of the drug price reduction policy, further research is needed on the long-term changes in such costs.

Disparities in avoidable hospitalization by income in South Korea: data from the National Health Insurance cohort.

Avoidable hospitalizations can act as an indicator for primary health care quality, in particular ambulatory care sensitive conditions (ACSCs) as hospitalizations for these conditions are generally considered avoidable through successful management. This study aimed to examine whether differences exist between income levels in rates of avoidable hospitalization.The South Korea National Health Insurance claims data from 2002 to 2013 were used. All hospitalizations were included and categorized into avoidable and non-avoidable cases. The independent variable was income level classified into quartiles and the dependent variable rates of avoidable hospitalization. Analysis was conducted using the generalized estimating equation (GEE) Poisson model. Subgroup analysis was performed based on chronic versus acute disease status and urban versus rural region. RESULTS: A total of 1 310 492 cases were included, in which the crude rate of avoidable hospitalizations was 1444.5 per 100 000 person years. Compared to the Q4 highest income group set as reference, the Q3 (RR 1.07, 95% CI 1.04-1.09), Q2 (RR 1.16, 95% CI 1.13-1.19) and Q1 (RR 1.20, 95% CI 1.17-1.24) income groups showed higher rates of avoidable hospitalizations. CONCLUSION: Risks of avoidable hospitalizations for ACSCs was higher in lower than higher income groups, implying that socioeconomic status is related to disparities in avoidable hospitalizations. The findings suggest the importance of monitoring the vulnerable groups identified in managing avoidable hospitalizations.

Implementation of the Chronic Disease Care System and its association with health care costs and continuity of care in Korean adults with type 2 diabetes mellitus.

BACKGROUND: The Chronic Disease Care System (CDCS) has been implemented in Korea to encourage treatment continuity in chronic disease patients. This study investigated the effect of the introduction of the CDCS on health care costs and continuity of care in individuals with type 2 diabetes mellitus (T2DM). METHODS: The National Health Insurance data from August, 2010 to March, 2012 (pre-policy) and from May, 2012 to December, 2013 (post-policy) were used. Introduction of the CDCS was defined as the intervention. The intervention group consisted of T2DM patients participating in the program and the control group patients not participating in the program. The Difference-in-Differences (DID) method was used to estimate the differences in total health care costs for outpatient services and continuity of care between the intervention and the control group before and after the intervention period. RESULTS: Implementation of the CDCS was associated with decreased health care costs (ß = - 46,877 Korean Won, P < 0.0001) and improved continuity of care (ß = 0.0536, P < 0.0001) in the intervention group with adjustment for covariates. CONCLUSION: Findings confirm an association between the adoption of the CDCS and reduced health care costs and improved continuity of care. The results reveal the potential benefits of reinforcing effective chronic disease management strategies in reducing health care costs and improving treatment continuity.

Management of Chronic Disease and Hospitalization Due to Diabetes among Type 2 Diabetes Patients in Korea: Using the National Sample Cohort Data 2002⁻2013.

To prevent negative outcomes for diabetes patients, developing self-management skills is imperative. This study aimed to examine the association between management of chronic disease (MCD), which mainly involves educating patients about their chronic diseases for obtaining self-management skills and hospitalization due to diabetes among type 2 diabetes patients in Korea. Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 54,031 type 2 diabetes patients were included in the study. If patients received the MCD within 1 year from the onset of diabetes, we categorized them as "MCD received patients" We reclassified these groups into five groups: "non-receiving", "1⁻3 times", "4⁻6 times", "7⁻9 times" and "10⁻12 times" The dependent variable of this study was hospitalization due to diabetes. Cox proportional hazard regression was used. Of the patients, 86.2% (n = 46,571) did not received the MCD within the 1 year from the onset of diabetes. The number of MCDs received increased and the hazard ratio (HR) for hospitalization due to diabetes decreased; particularly, patients who received MCD 10⁻12 times per annum showed the lowest HR for hospitalization due to diabetes compared to patients in the MCD non-received group (1⁻3 times per annum: HR: 0.81, p = 0.0001; 4⁻6 times per annum: HR: 0.82, p = 0.0248; 7⁻9 times per annum: HR: 0.75, p = 0.0054; 10⁻12 times per annum: HR: 0.61, p < 0.0001). Considering the importance of raising self-managing diabetes skills, the findings can aid in determining the outcomes of the MCD program.

Do Reduced Copayments Affect Mortality after Surgery due to Stroke? An Interrupted Time Series Analysis of a National Cohort Sampled in 2003-2012.

BACKGROUND: The South Korean government introduced a policy in 2 phases, in September 2005 and in January 2010, for reducing copayments for patients with critical diseases, including stroke, to prevent excessive medical expenditures and to ease economic barriers. Previous studies of the effect of this policy were focused primarily on cancer. Therefore, we investigated the relationship between this policy and 1-year mortality after surgery among patients with stroke. METHODS: We used data from the Korean National Health Insurance sampling cohort (n = 2173 in 2003-2012) and performed an interrupted time series analysis. RESULTS: Approximately 26% of the patients died within 1 year after surgery. The time trends after reducing copayments from 10% to 5% (phase 2) were inversely associated with risk of 1-year mortality (relative risk = .855, 95% confidence interval: .749-.975; P = .0196). In addition, this inverse association was greater in patients with low incomes, of older ages, and with higher Charlson comorbidity indices. CONCLUSIONS: The introduction of a policy for reducing copayments to ease excessive cost burdens for patients with stroke was positively associated with a reduced risk of 1-year mortality after surgical treatment due to stroke. On the basis of our results, health policy makers should make an effort to identify vulnerable populations and to overcome economic barriers for providing effective alternatives to ensure patients receive optimal health care.

Cross-level interaction between individual socioeconomic status and regional deprivation on overall survival after onset of ischemic stroke: National health insurance cohort sample data from 2002 to 2013.

INTRODUCTION: The literature on stroke mortality and neighborhood effect is characterized by studies that are often Western society-oriented, with a lack of racial and cultural diversity. We estimated the effect of cross-level interaction between individual and regional socioeconomic status on the survival after onset of ischemic stroke. METHODS: We selected newly diagnosed ischemic stroke patients from 2002 to 2013 using stratified representative sampling data of 1,025,340 subjects. A total of 37,044 patients over the 10 years from 2004 to 2013 had newly diagnosed stroke. We calculated hazard ratios (HR) of 12- and 36-month mortality using the Cox proportional hazard model, with the reference group as stroke patients with high income in advantaged regions. RESULTS: For the middle income level, the patients in advantaged regions showed low HRs for overall mortality (12-month HR 1.27; 95% confidence interval [CI], 1.13-1.44; 36-month HR 1.25; 95% CI, 1.14-1.37) compared to the others in disadvantaged regions (12-month HR 1.36; 95% CI, 1.19-1.56; 36-month HR 1.30; 95% CI, 1.17-1.44). Interestingly, for the low income level, the patients in advantaged regions showed high HRs for overall mortality (12-month HR 1.27; 95% CI, 1.13-1.44; 36-month HR 1.33; 95% CI, 1.22-1.46) compared to the others in disadvantaged regions (12-month HR 1.25; 95% CI, 1.09-1.43; 36-month HR 1.30; 95% CI, 1.18-1.44). CONCLUSION: Although we need to perform further investigations to determine the exact mechanisms, regional deprivation, as well as medical factors, might be associated with survival after onset of ischemic stroke in low-income patients.

Deregulation of sale of over-the-counter drugs outside of pharmacies in the Republic of Korea: interrupted-time-series analysis of outpatient visits before and after the policy.

BACKGROUND: We evaluated the effectiveness of a policy allowing for the sale of over-the-counter drugs outside of pharmacies by examining its effect on number of monthly outpatient visits for acute upper respiratory infections, dyspepsia, and migraine. METHOD: We used medical claims data extracted from the Korean National Health Insurance Cohort Database from 2009 to 2013. The Korean National Health Insurance Cohort Database comprises a nationally representative sample of claims - about 2% of the entire population - obtained from the medical record data held by the Korean National Health Insurance Corporation (which has data on the entire nation). The analysis included26,284,706 person-months of 1,042,728 individuals. An interrupted-time series analysis was performed. Outcome measures were monthly outpatient visits for acute upper respiratory infections, dyspepsia, and migraine. To investigate the effect of the policy, we compared the number of monthly visits before and after the policy's implementation in 2012. RESULT: For acute upper respiratory infections, monthly outpatient visits showed a decreasing trend before the policy (ß = -0.0003);after it, a prompt change and increasing trend in monthly outpatient visits were observed, but these were non-significant. For dyspepsia, the trend was increasing before implementation (ß = -0.0101), but this reversed after implementation(ß = -0.007). For migraine, an increasing trend was observed before the policy (ß = 0.0057). After it, we observed a significant prompt change (ß = -0.0314) but no significant trend. CONCLUSION: Deregulation of selling over-the-counter medication outside of pharmacies reduced monthly outpatient visits for dyspepsia and migraine symptoms, but not acute upper respiratory infections.

The association between number of doctors per bed and readmission of elderly patients with pneumonia in South Korea.

BACKGROUND: There is an urgent need to reduce readmission of patients with pneumonia and improve quality of care. To assess the association between hospital resources and quality of care, we examined the effect of number of doctors per bed on 30-day readmission and investigated the combined effect of number of doctors per bed and number of beds. METHODS: We used nationwide cohort sample data of health insurance claims by the National Health Insurance Service (NHIS) from 2002 to 2013. Pneumonia admissions to acute care hospitals among 7446 inpatients older than 65 were examined. We conducted a multivariate Cox proportional hazard model to analyze the association between the number of doctors per bed and 30-day readmission, as well as that of pneumonia-specific 30-day readmission with the combined effects of number of doctors per bed and number of beds. RESULTS: Overall, 1421 (19.1%) patients were readmitted within 30 days and 756 (11.2%) patients were readmitted for pneumonia within 30 days. Patients with pneumonia treated by very low or low number of doctors per bed showed higher readmission (pneumonia-specific readmission: hazard ratio [HR] = 1. 406, 95% confidence interval [CI] = 1.072-1.843 for low number of doctors per bed; all-cause readmissions: HR = 1.276, 95% CI = 1.026-1.587 for very low number of doctors per bed, and HR = 1.280, 95% CI = 1.064-1.540 for low number of doctors per bed). CONCLUSIONS: This empirical study showed that patients with pneumonia cared for in hospitals with more doctors were less likely to be readmitted. Pneumonia-specific 30-day readmission was also significantly associated with the combined effect of the number of doctors and the number of hospital beds.

Do hospital characteristics influence Cesarean delivery? Analysis of National Health Insurance claim data.

Background: The rates of Cesarean delivery in South Korea are high among the Organization for Economic Cooperation and Development countries. We analyzed the relationship between hospital characteristics, in particular hospital volume and market competition and Cesarean delivery. Methods: We used data from National Health Insurance claims (n = 53 591) at 51 hospitals to analyze the relationship between hospital characteristics and Cesarean delivery between 2010 and 2013. We performed logistic regression analysis using generalized estimating equations models that included both inpatient and hospital variables to examine factors associated with Cesarean delivery. Results: Among 53 591 hospitalization cases, 14 425 (26.9%) patients underwent Cesarean delivery. Hospital volumes for deliveries were inversely associated with Cesarean delivery (per increases 100 deliveries = OR 0.896, 95% CI 0.887-0.905). Market competition had inverse relationship with Cesarean delivery (per increase in 10 Hirschmann-Herfindal index points; OR 0.982, 95% CI 0.979-0.985). Conclusions: Our findings suggest that hospital characteristics affect Cesarean delivery. These situations might be caused by maintaining profit with regard to survival or competition, and protecting themselves against unexpected delivery risks. Therefore, based on our findings, health policy makers must make an effort to implement effective strategies for the optimal management of excessive Cesarean rates in South Korea.

Mortality in Schizophrenia and Other Psychoses: Data from the South Korea National Health Insurance Cohort, 2002-2013.

Individuals with psychoses show excess mortality, which is a major public health concern. This study examined all-cause and suicide mortality rates in Korean patients diagnosed with schizophrenia, mood disorder, or mental and behavioral disorder due to psychoactive substance use and to compare this with that of the general population. Data were from the National Health Insurance cohort, 2002 to 2013. A total of 107,190 cases aged 15 years or over were included. Mortality rates per 100,000 person years (PY) were obtained. Poisson regression modelling was conducted to quantify the effect of baseline characteristics on all-cause and suicide mortality risks. Standardized mortality ratios (SMRs) were also calculated. All-cause mortality was the highest among mental and behavioral disorder patients (1,051.0 per 100,000 PY), followed by schizophrenia (949.1 per 100,000 PY) and mood disorder patients (559.5 per 100,000 PY). Highest suicide mortality was found in schizophrenia (177.2 per 100,000 PY), mental and behavioral disorder (143.7 per 100,000 PY), and mood disorder patients (59.7 per 100,000 PY). The rate ratios (RRs) for all-cause and suicide mortality were reduced for younger populations and women. Psychoses patients had higher all-cause (schizophrenia, SMR 2.4; 95% confidence interval [CI] 2.2-2.5; mood disorder, SMR 1.4; 95% CI 1.3-1.5; mental and behavioral disorder, SMR 2.6; 95% CI 2.5-2.8) and suicide (schizophrenia, SMR 8.4; 95% CI 7.2-9.6; mood disorder, SMR 2.8; 95% CI 2.1-3.5; mental and behavioral disorder, SMR 6.8; 95% CI 5.7-7.9) mortality rates than the general population. These findings infer that efforts should be made to reduce excess mortality in psychoses.

Are sleep disorders associated with increased mortality in asthma patients?

BACKGROUND: South Korea has experienced problems regarding poor management of symptoms of asthma patients and remarkable increases in sleep disorders. However, few studies have investigated these issues. We examined the relationship between sleep disorders and mortality in asthma patients to suggest effective alternatives from a novel perspective. METHODS: We used data from the National Health Insurance Service (NHIS) National Sample Cohort 2004-2013, which included medical claims filed for 186,491 patients who were newly diagnosed with asthma during the study period. We performed survival analyses using a Cox proportional hazards model with time-dependent covariates to examine the relationship between sleep disorders and mortality in asthma patients. RESULTS: There were 5179 (2.78%) patients who died during the study period. Sleep disorders in patients previously diagnosed with asthma were associated with a higher risk of mortality (hazard ratio [HR]: 1.451, 95% confidence interval [CI]: 1.253-1.681). In addition, significant interaction was found between sleep disorders and Charlson comorbidity index. CONCLUSIONS: Our findings suggest that an increased prevalence of sleep disorders in asthma patients increases the risk of mortality. Considering the worsening status of asthma management and the rapid growth of sleep disorders in South Korea, clinicians and health policymakers should work to develop interventions to address these issues.

Higher cost sharing for visiting general hospitals and the changing trend in the first-visited healthcare organization among newly diagnosed hypertension patients.

Unnecessary use of high-quality resources in general hospitals hinders treatment of patients with urgent and complicated conditions. Thus, the Korean Government has sought to reduce general hospital visiting of patients with 52 mild diseases, including hypertension. The higher cost sharing for medical expenses and medications from general hospitals were enacted in 2009 and 2011, respectively.We determined whether these regulations were effective through evaluating changing trends in first-visited healthcare organizations and defined the first visiting healthcare organization level (primary clinics, hospital, and general hospital) as an outcome measure.Data of 32,830 mild hypertension patients from 2004 to 2013 were retrieved from the Korean National Health Insurance Service National Sample Cohort. This was a retrospective study involving a large national cohort with patient samples (representing 2% of the total Korean population) stratified on the basis of sociodemographic information.Mutinomial logistic regression were performed for the first visiting to different health organizations, compared to the first visiting to primary clinics.Patients in 2012 and 2013 had significantly lower odds ("2012": 0.68, 95% confidence interval [CI]: 0.56-0.81/"2013": 0.66, 95% CI 0.54-0.81) of first visiting general hospitals compared with those in 2008, although decreased tendencies (albeit nonsignificant) were already evident in 2010 and 2011.Thus, government health policies for cost-containment seem effective in decreasing first visiting of general hospitals among patients with mild essential hypertension. These policies have since extended to Medical Aid beneficiaries; thus, it is needed to continue monitor their results carefully.

Sleep disorders and risk of hospitalization in patients with mood disorders: Analysis of the National Sample Cohort over 10 years.

Medical utilization due to organic sleep disorders has increased remarkably in South Korea, which may contribute to the deterioration of mental health in the population. We analyzed the relationship between organic sleep disorders and risk of hospitalization due to mood disorder. We used data from the National Health Insurance Service (NHIS) National Sample Cohort 2002-2013, which included medical claims filed for the 15,537 patients who were newly diagnosed with a mood disorder in a metropolitan region, and employed Poisson regression analysis using generalized estimating equation (GEE) models. By the results, there was a 0.53% hospital admission rate among 244,257 patients with outpatient care visits. Patients previously diagnosed with an organic sleep disorder before specific outpatient care had a higher risk for hospitalization. Such associations were significant in females, patients with a longer duration of disease, or those who lived in the largest cities. In conclusion, considering that experiencing a sleep disorder by a patient with an existing mood disorder was associated with deterioration of their status, health policy makers need to consider insurance coverage for all types of sleep disorders in patients with psychological conditions.

Positive effects of medical staffing on readmission within 30 days after discharge: a retrospective analysis of obstetrics and gynecology data.

BACKGROUND: Improving quality of care is a major healthcare goal; however, the relationship between limited resources and appropriate healthcare distribution has always been problematic. Planning for resource shortages is important for improving healthcare quality. The aim of our study was to evaluate the effects of manpower planning on improvements in quality of care by estimating the effects of medical staffing on readmission within 30 days after discharge. METHODS: We conducted an observational study using 2011-14 National Health Claim data from 692 hospitals and 633 461 admissions. The database included information on uterine (including adnexa) procedures (195 270 cases) and cesarean deliveries (438 191 cases). The outcome variable was readmission within 30 days after discharge. A generalized estimating equation model was used to evaluate associations between readmission and medical staffing. RESULTS: The number of doctors and the proportion of registered nurses (RNs) were significantly associated with a lower risk of readmission within 30 days (proportion of RNs, Relative Risk (RR): 0.97, P values: 0.0025; number of doctors, RR: 0.96, P values: <0.0001). The number of nurses (RNs + licensed practical nurses) was not associated with readmission within 30 days (RR: 1.01, P values: <0.0001). CONCLUSION: Our results suggested that higher numbers of doctors and higher proportions of RNs were positively correlated with a lower risk of readmission within 30 days. Human resource planning to solve manpower shortages should carefully consider the qualitative aspects of clinical care and include long-term planning.

Disparities in the experience and treatment of dental caries among children aged 9-18 years: the cross-sectional study of Korean National Health and Nutrition Examination Survey (2012-2013).

BACKGROUND: The aim of this study is to examine the association between parental socioeconomic status (SES) and the experience as well as treatment of dental caries among children aged 9 to 18 years. METHODS: Data from 1253 children aged 9-18 years from the Korean National Health and Nutrition Examination Survey (2012-2013) were analyzed. Parental socioeconomic status was measured using household income level and maternal educational level. The decayed, missing, and filled teeth (DMFT) index was used to measure experience of dental caries (DMFT ≥ 1). Non-treatment of dental caries was measured according to whether the participants who experienced dental caries used a dental service at a dental clinic to treat caries during the previous year. Logistic regression was used to investigate the association between parental socioeconomic status and the experience of dental caries as well as the association between parental socioeconomic status and the non-treatment of dental caries among children that have experienced caries. RESULTS: A total of 808 subjects (64.5 %) experienced dental caries among 1253 participants, and 582 of these 808 subjects (72.0 %) did not receive treatment among those having experience of dental caries. Parental socioeconomic status was not associated with experience of dental caries. However, those from low- and middle-income households were less likely to receive treatment than those from high-income households (odds ratio [OR] 2.11 [95 % confidence interval (CI) 1.16-3.86], OR 2.14 [95 % CI 1.27-3.62]). In particular, those from low- and middle-income households who had regular dental checkups were more likely to have untreated caries than those from high-income households (OR 3.58 [95 % CI 1.25-10.24]). CONCLUSIONS: This study demonstrates the parental household income-related disparities in children's dental health treatment. Efforts should be made to lower financial barriers to dental health services, particularly among those from low-income households, in order to reduce dental health disparities in the treatment of caries in children.