Determinants of Legislation on Social Health Insurance in Transition Countries.

This study aims to address the question: Why did transition countries enact laws related to social health insurance (SHI) at different times, even though they experienced dissolution of the Soviet Union at the same time in the early 1990s? We used Ragin's fuzzy-set qualitative comparative analysis to investigate the configurations of causal conditions that affected the speed of developing SHI-related legislation in 24 post-socialist countries. The potential causal conditions were health status, economic status, level of governance, level of democracy, issue salience, and number of medical professionals. We found 3 pathways that led to the enactment of SHI-related laws and 1 pathway that inhibits enactment. The key factors impacting enactment of SHI-related laws were non-corrupt governments and realization of democracy. In addition, medical professionals' involvement in policymaking could be the factor to enact SHI-related laws. Further research is needed for more in-depth analysis regarding what the laws specifically include, type of health insurance systems that were adopted based on the laws, and if the legislation contributed toward achieving universal health coverage.

Risk perception of nuclear power plants among university students in Northeast Asia after the Fukushima nuclear disaster.

To examine the perception of nuclear energy risks among Asian university students following the Fukushima nuclear disaster, a standardized questionnaire survey was conducted since July 2011 after the Fukushima disaster. A total of 1814 respondents from 18 universities in China, Japan, Korea, and Taiwan participated in this survey. It showed that students with the following characteristics had a higher preference for "a clear schedule to phase out nuclear power plant (NPP)": females (adjusted odds ratio [aOR] = 1.84, 95% confidence interval [CI] = 1.44-2.34), in Japan (aOR = 2.81, 95% CI = 2.02-3.90), in China (aOR = 1.48, 95% CI = 1.04-2.09), and with perceived relative risks of cancer incidence greaterthan 1 (aOR = 1.42, 95% CI = 1.07-1.88). "If nuclear energy were phased out," the opinions on potential electricity shortage were as follows: Japan, aOR = 0.53, 95% CI = 0.40-0.69; China, aOR = 2.46, 95% CI = 1.75-3.45; and associated with academic majors (science/technology, aOR = 0.43, 95% CI = 0.31-0.59; medicine/health science, aOR = 0.64, 95% CI = 0.49-0.84). The results carried essential messages for nuclear energy policy in East Asia.

Globalization of public health law and ethics.

The Constitution of the World Health Organization (1946) states that the "enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social position." The international legal framework for this right was laid by the Universal Declaration of Human Rights (1948) and reaffirmed in the International Covenant on Economic, Social, and Cultural Rights (1966) and the Declaration of Alma-Ata (1978). In recent years, the framework has been developed on 10 key elements: national and international human rights, laws, norms, and standards; resource constraints and progressive realization; obligations of immediate effect; freedoms and entitlements; available, accessible, acceptable, and good quality; respect, protect, and fulfill; non-discrimination, equality, and vulnerability; active and informed participation; international assistance and cooperation; and monitoring and accountability. Whereas public health law plays an essential role in the protection and promotion of the right to health, the emergence of SARS (2003) highlighted the urgent need to reform national public health laws and international obligations relating to public health in order to meet the new realities of a globalized world, leading to the WHO Framework Convention on Tobacco Control (2003) and the revision of the WHO International Health Regulations (2005). The Asian Institute for Bioethics and Health Law, in conjunction with the Republic of Korea's Ministry of Health and Welfare and the WHO International Digest of Health Legislation, conducted a comparative legal analysis of national public health laws in various countries through a project entitled Domestic Profiles of Public/Population Health Legislation (2006), which underscored the importance of recognizing the political and social contexts of distinct legal cultures, including Western, Asian, Islamic, and African.

Developing a tool for assessing public health law in countries.

At present, the World Health Organization (WHO) is in the process of developing a tool designed to assess the status of public health legislation in a given country. An Expert Consultation on Public Health Law was convened in Manila, Philippines, in May 2011. The participants agreed that the tool could serve as a guide for a regional approach to assist Member States in assessing the scope, completeness, and adequacy of their public health law. Given the broad definition of "public health" and the laws that affect health, directly or indirectly, the participants further agreed to narrow the field to 4 areas based on significant WHO works/policies, each organized into an independent module: (1) International Digest on Health Law, (2) Primary Health Care, (3) International Health Regulations 2005, and (4) Framework Convention on Tobacco Control. The tool would be drafted in a questionnaire format that asks the respondent to determine whether primary and/or subsidiary legislation exists in the country on a specific topic and, if so, to cite the relevant law, describe the pertinent points, and attach and/or link to the full text where available. The participants agreed that the respondents should include government officials and/or academics with legal competency. Version 1 of the tool was piloted in the Philippines, the Republic of Korea, Samoa, and Vanuatu. At a 2nd Expert Consultation on Public Health Law, convened in Incheon, Republic of Korea, in October 2011, in conjunction with the 43rd Conference of the Asia-Pacific Academic Consortium on Public Health, the participants determined that the tool was generally usable, certain concerns notwithstanding, such as the risk of standardizing compliance with WHO policies. The agreed next step is to finalize the analysis tool by August 2012, marking the end of stage I in the development process. Stage II will consist of team building and networking of responsible officers and/or professionals in the countries. The tool will be further developed to reflect specific in-country situations.

Factors associated with participation of Korean women in cervical cancer screening examination by age group.

PURPOSE: Cervical cancer is the 6th most common cancer among Korean women, and the prevalence of cervical cancer was 21.9 (per 100,000) in 2008. This study was designed to identify factors associated with Korean women' s participation by age group in cervical cancer screening. METHODS: Based on the 2007-2009 Korea Health and Nutrition Examination Survey, we studied 6,964 women who were 30 years or older without a history of cervical cancer and completed a health questionnaire, physical examination, and nutrition examination. Information about their participation in cervical cancer screening examination was collected using a self-administered questionnaire. Multiple logistic regression was performed to identify factors associated with their participation in cervical cancer screening over the last 2 years. RESULTS: Approximately 51.9% of women had been screened for cervical cancer over the previous 2 years. Women aged 65 years or older were less likely to undergo the screening than women aged 30-64 years. In the multiple logistic regression analysis, private health insurance, smoking, and body mass index were significantly associated with participation of women aged 30-44 years old in cervical cancer screening examination. Education, health insurance type, private health insurance, and smoking were significantly associated with the participation rate for women aged 45-64 years old. Participation of women aged 65 years or older was associated with private health insurance, body mass index, oral contraceptives, hormone replacement therapy, age at first birth, and number of pregnancies. CONCLUSION: Indicators of socio-demographic factors, health behavioral factors and reproductive factors seem to have varying impacts on Korean women' s participation in cervical cancer screening according to age group. These results demonstrate the need for more aggressive and age-based interventions and policy programs to improve the cervical cancer screening rate.

A Korean perspective on developing a global policy for advance directives.

Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible.

Development of the Korean Academy of Medical Sciences Guideline for rating physical impairment.

Systematic and effective welfare for the disabled is possible when there are scientific and objective criteria demonstrating either presence or severity of the impairment. We need our own scientific criteria suitable for our culture and society, since the impairment is influenced by them. In 2007, we established the Developing Committee of Korean Academy of Medical Sciences (KAMS) Guideline for Impairment Rating under KAMS supervision. We included all fixed and permanent physical impairments after a sufficient medical treatment. The impairment should be stable and medically measurable. If not, it should be reevaluated later. We benchmarked the American Medical Association Guides. The KAMS Guideline should be scientific, objective, valid, reasonable and practical. In particular, we tried to secure objectivity. We developed the KAMS Guideline for Impairment Rating.