The effect of catastrophic health expenditure on exit from poverty among the poor in South Korea.

The study aims to examine the effect of catastrophic health expenditure (CHE) on exit from poverty among the poor at the poverty line of less than 40% of median income level (MIL), analysing data from the Korean Welfare Panel Study 2008-2016 through a discrete time event history analysis. Effects of CHE on poverty exit were different between exit to near-poverty and exit to non-poverty. Households facing CHE were less likely to exit from poverty to near-poverty at the CHE thresholds of 20%-30%; however, effects of CHE were not associated with exiting from poverty to non-poverty. Considering the majority of types of exit from poverty were exit to near-poverty (about 70%), this result would raise concerns that occurrences of CHE may pose a big threat to their already limited household budget of the poor. Combined loss of income due to ill health and financial burden due to health care may force the poor to be stuck at poverty. The study was the first exploratory study in South Korea to examine the effect of CHE on exit from poverty. This study is expected to contribute to better understanding of the economic consequences of out-of-pocket payments due to health care among the poor over time. Reduction in the incidence of CHE by expanding the benefits coverage of the national health insurance in Korea can be an important step to reduce poverty.

Anterior Nasal Spine Relocation With Cleft Orthognathic Surgery.

BACKGROUND: In unilateral cleft nasal deformity, the skeletal, and cartilaginous framework of nose is deformed. The anterior nasal spine (ANS) is usually displaced to the non-cleft-side. In cleft orthognathic surgery, ANS relocation can help correct the deviated ANS and nasal septum and might lead to an improved esthetic and functional outcome. METHODS: Patients with unilateral cleft lip who underwent two-jaw orthognathic surgery between July 2016 and July 2020 were reviewed retrospectively. During conventional two-jaw orthognathic surgery, the ANS was separated from the maxilla. The separated ANS with the attached septum was fixed on the maxillary midline by wiring. Computed tomography scan was used to measure the septal deviation angle and septal deviation from the midline. RESULTS: The septal deviation from the maxillary midline decreased following surgery (preoperative versus postoperative: 4.6 ±â€Š1.0 mm versus 3.2 ±â€Š1.2 mm; P = 0.016). The coronal septal deviation angle was widened after ANS relocation, although the transverse septal deviation angle remained unchanged (coronal septal deviation angle, preoperative versus postoperative: 146.7 ±â€Š12.6 versus 159.8 ±â€Š7.6; P = 0.01; transverse septal deviation angle, preoperative versus postoperative: 156.5 ±â€Š11.7 versus 162.8 ±â€Š7.7; P = 0.128). CONCLUSIONS: This study suggests that simultaneous ANS relocation with orthognathic surgery is a viable option for cleft-related deformities, considering the resultant caudal septum straightening and stable structural support observed in the long-term.

Moderating effect of cognitive reserve on the association between grey matter atrophy and memory varies with age in older adults.

BACKGROUND: Educational attainment and verbal intelligence, which indirectly reflect an individual's cognitive reserve (CR), is suggested to buffer the effect of late-life brain degradation on cognitive performance outcome. We aimed to explore how the relationship between whole grey matter volume (GMV) and episodic memory function is altered by CR proxy as well as age in healthy older adults. METHODS: Elderly Verbal Learning Test (EVLT) and structural magnetic resonance imaging were administered to 110 community-residing older adults. Moderated moderation model tested whether the association between whole GMV and episodic memory was moderated by both CR and chronological age. RESULTS: The results showed that the moderating effect of CR on Immediate Recall, Short-delay Recall, and Recognition scores of EVLT differed across age groups. The elderly with higher CR showed steeper GMV effect on EVLT at the Age-Younger condition, while such moderating effect was reversed in the Age-Older condition, suggesting an alleviated brain atrophy effect in higher CR elderly. CONCLUSION: These findings suggest that although higher CR elderly may exhibit earlier GMV-related memory decline, the buffering effect of CR on the cognitive decline due to brain atrophy would become more evident in old-old elderly people who are likely to have accumulated more neuropathological changes. This study underscores chronological age as an important moderating factor in examining the moderating role of CR in late-life memory function.

Adverse selection and supply-side factors in the enrollment in community-based health insurance in Northwest Ethiopia: A mixed methodology.

BACKGROUND: Since 2010, the Ethiopian government introduced different measures to implement community-based health insurance (CBHI) schemes to improve access to health service and reduce the catastrophic effect of health care costs. OBJECTIVES: The aim of this study was to examine the determinants of enrollment in CBHI in Northwest Ethiopia. METHODS: In this study, we utilized a mix of quantitative (multivariate logistic regression applied to population survey linked with health facility survey) and qualitative (focus group discussion and in-depth interview) methods to better understand the factors that affect CBHI enrollment. RESULTS: The study revealed important factors, such as household, informal association, and health facility, as barriers to CBHI enrollment. Age and educational status, self-rated health status, perceived quality of health services, knowledge, and information (awareness) about CBHI were among the characteristics of individual household head, affecting enrollment. Household size and participation in an informal association, such as local credit associations, were also positively associated with CBHI enrollment. Additionally, health facility factors like unavailability of laboratory tests were the main factor that hinders CBHI enrollment. CONCLUSIONS: This study showed a possibility of adverse selection in CBHI enrollment. Additionally, perceived quality of health services, knowledge, and information (awareness) are positively associated with CBHI enrollment. Therefore, policy interventions to mitigate adverse selection as well as provision of social marketing activities are crucial to increase enrollment in CBHI. Furthermore, policy interventions that enhance the capacity of health facilities and schemes to provide the promised services are necessary.

Has the National Cancer Screening Program reduced income inequalities in screening attendance in South Korea?

PURPOSE: In 1999, the Korean government introduced the National Cancer Screening Program (NCSP) to increase the cancer-screening rate, particularly among the low-income population. This study investigates how the NCSP has decreased both relative and absolute income inequalities in the uptake of cancer screening in South Korea. METHODS: A nationally representative cross-sectional repeated data from the Korea National Health and Nutrition Examination Survey 1998-2012, managed by the Ministry of Health and Welfare, was used to assess changes over time and the extent of discontinuity at the NCSP-recommended initiation age in the uptake of screening for breast, colorectal, and gastric cancers across income quartiles. RESULTS: Relative inequalities in the uptake of screening for all cancers decreased significantly over the policy period. Absolute inequalities did not change for most cancers, but marginally increased from 9 to 14% points in the uptake of screening for colorectal cancer among men. At the recommended initiation age, absolute inequalities did not change for breast and colorectal cancers but increased from 5 to 16% points for gastric cancer, for which relative inequality significantly decreased. CONCLUSIONS: The NCSP, which reduced out-of-pocket payment, may not decrease absolute gap although it leads to overall increases in the uptake of cancer screening and decreases in relative inequalities. Further investigations are needed to understand barriers that prevent the low-income population from attending cancer screening.

The Effects of Intellectual Property Rights on Access to Medicines and Catastrophic Expenditure.

Since the introduction of Trade-Related Aspects of Intellectual Property Rights (TRIPS) in 1995, there has been considerable concern that poor access to essential medicines in developing countries would be exacerbated because strengthening intellectual property rights (IPR) leads to monopoly of pharmaceutical markets and delayed entry of lower-cost generic drugs. However, despite extensive research and disputes regarding this issue, there are few empirical studies on the topic. In this study, we investigated the effect of IPR on access to medicines and catastrophic expenditure for medicines, using data from World Health Surveys 2002-2003. The index of patent rights developed by Ginarte and Park (1997) was used to measure the IPR protection level of each country. Estimates were adjusted for individual and country characteristics. In the results of multilevel logistic regression analyses, higher level of IPR significantly increased the likelihood of nonaccess to prescribed medicines even after controlling for individual socioeconomic status and national characteristics associated with access to medicines. This study's finding on the negative impact of IPR on access to medicines calls for the implementation of more active policy at the supra-national level to improve access in low- and middle-income countries.

The effect of extension of benefit coverage for cancer patients on health care utilization across different income groups in South Korea.

To provide financial protection against catastrophic illness, the Korean government expanded the National Health Insurance (NHI) benefit coverage for cancer patients in 2005. This paper examined whether the policy improved the income-related equality in health care utilization. This study analyzed the extent to which the policy improved income-related equality in outpatient visits, inpatient days, and inpatient and outpatient care expenditure based on triple difference estimator. Using nationwide claims data of the NHI from 2002 to 2004 and from 2006 to 2010, we compared cancer patients as a treatment group with liver disease as a control group and low-income group with the highest-income group. The results showed that the extension of NHI benefits coverage led to an increase in the utilization of outpatient services across all income groups, but with a greater increase for the low-income groups, among cancer patients. Moreover, the policy led to a less decrease in the utilization of inpatient services for the low-income group while it decreased across all income groups. Our finding suggests that the extension of NHI benefits coverage improved the income-related equality in health care utilization.

Association of Primary Care Physician Supply with Population Mortality in South Korea: A Pooled Cross-Sectional Analysis.

BACKGROUND: Primary care physicians perform a comprehensive role by providing continuous, patient-centered, and accessible healthcare and establishing connections with specialized care. However, the association between the supply of primary care physicians and mortality rates in South Korea has not been thoroughly investigated. METHODS: This study utilized data from 229 si-gun-gu in South Korea from 2016 to 2020. The densities of primary care physicians, physicians in functional primary clinics, specialists in primary care facilities, and active physicians per 100,000 people were independent variables. Age-adjusted all-cause mortality and cause-specific mortality rates per 100,000 individuals were the dependent variables. Negative binomial regression, negative binomial regression with a pseudo-panel approach, and geographically weighted regression were used to analyze the data. RESULTS: Our study revealed a significant negative association between the density of primary care physicians and all-cause mortality. An increase in a primary care physician per 100,000 population was significantly linked to a 0.11% reduction in all-cause mortality (incidence rate ratio, 0.9989; 95% confidence interval, 0.9983-0.9995). Similar associations have been observed between mortality rates owing to cardiovascular diseases, respiratory tract diseases, and traffic accidents. CONCLUSION: This study provides evidence that having a higher number of primary care physicians in South Korea is associated with lower mortality rates. Future research should consider better indicators that reflect the quality of primary care to better understand its impact on population health outcomes. These findings emphasize the significance of strengthening primary care in the South Korean healthcare system to improve the overall health and wellbeing.

Has South Korea achieved the goals of national health insurance? Trends in financial protection of households between 2011 and 2018.

This study aims to investigate the evolution of financial protection of households against OOP in South Korea, where subsequent policies of expanding benefit coverage have been implemented primarily focusing on several severe diseases, by measuring catastrophic healthcare expenditure (CHE) and the characteristics of households vulnerable to CHE. Using the Korea Health Panel 2011-2018, this study analyzed CHE trends by the targeted severe diseases and other health problems and household income and examined the determinants of CHE using binary logistic regression. Our findings showed that CHE decreased in households with the targeted severe diseases but increased in households experiencing hospitalization that were not related to the targeted diseases, which appeared to have a significantly higher likelihood of CHE in 2018 than households with the targeted severe diseases. In addition, CHE was more prevalent and increased or remained stagnant among households whose heads had health problems than others. Inequalities in CHE also increased, showing increased Concentration Index (CI) and increased incidences of CHE in the lower income quartile during the study period. These results suggest that the current policies are insufficient to achieve its financial protection goals against healthcare expenditure in South Korea. In particular, benefit expansions targeting a specific disease may cause inequitable distribution of resources and may not enhance protection against households' financial burden.

Effects of public long-term care insurance on the medical service use by older people in South Korea.

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.

Social inequalities in life expectancy and mortality during the transition period of economic crisis (1993-2010) in Korea.

BACKGROUNDS: This study examines social inequalities in life expectancy and mortality during the transition period of the Korean economic crisis (1993-2010) among Korean adults aged 40 and over. METHODS: Data from the census and the national death file from the Statistics Korea are employed to calculate life expectancy and age-specific-death-rates (ASDR) by age, gender, and educational attainment for five years: 1993, 1995, 2000, 2005, and 2010. Absolute and relative differences in life expectancy and Age-Specific Death Rates by educational attainment were utilized as proxy measures of social inequality. RESULTS: Clear educational gradient of life expectancy was observed at age 40 by both sexes and across five time periods (1993, 1995, 2000, 2005, and 2010). The gradient became notably worse in females between 1993 and 2010 compared to the trend in males. The educational gradient was also found for ASDR in all five years, but it was more pronounced in working age groups (40s and 50s) than in elderly groups. The relative disadvantage of ASDR among working age Korean adults, both males and females, became substantially worse over time. CONCLUSIONS: Social inequalities in life expectancy and ASDR of the working age group across socioeconomic status over time were closely related to the widening of the social difference created by the macroeconomic crisis and the expansion of neo-liberalism in Korea.

Factors affecting the prescribing patterns of antibiotics and injections.

There are serious problems concerning the inadequate prescription of antibiotics and overuse of injections in primary care. However, the determinants of prescription patterns in Korea are not well-documented. To examine the area characteristics affecting the prescription of antibiotics and injections in primary care practices in the treatment of respiratory tract infections (RTIs), a nationwide cross-sectional study was performed in all 250 administrative districts of Korea. The outcome was modeled as a binary variable: over-prescription or not compared with the nation-wide average. Over-prescription of antibiotics was associated with the ratio of specialists to general physicians and over-prescription in previous years in the area (adjusted odds ratio [aOR], 4.8; 95% confidence interval [CI] 1.5-14.8; and aOR, 12.0; 95% CI 5.5-25.9, respectively). Over-use of injections was associated with younger population, urban living and the number of hospital beds in the area (aOR, 0.2; 95% CI 0.1-0.4; aOR, 0.3; 95% CI 0.1-0.8; and aOR, 0.4, 95% CI 0.2-0.9; respectively). There were differences in the prescribing patterns in different districts; prescription patterns were affected more by supply factors than by demand factors. Highly competitive medical environment associated with supply factors is a significant determinant of prescription patterns in Korea.

Surgery-First Orthognathic Approach to Correct Facial Asymmetry: Artificial Intelligence-Based Cephalometric Analysis.

BACKGROUND: The surgery-first orthognathic approach has been applied at our institution since 2007. However, its indications remain debated. The aim of this study was to investigate the reliability of the surgery-first approach to correct facial asymmetry compared to the traditional orthodontics-first approach using a novel artificial intelligence-based cephalometric analysis. METHODS: Intervention outcomes of surgery-first (n = 33) and orthodontics-first (n = 26) approaches to correct facial asymmetry were examined. Patients with facial asymmetry who had undergone orthognathic surgery from January of 2006 to January of 2019 were included in the study. In the surgery-first approach, the novel preoperative simulation process on the dental model was performed to determine the final occlusion without presurgical orthodontic treatment. Changes in cephalometric landmarks were compared using the supervised deep learning process developed at our institution. RESULTS: The surgery-first approach without presurgical orthodontic treatment corrected facial asymmetry and yielded results similar to those of the traditional orthognathic approach. The statistical analysis revealed that changes in skeletal cephalometric landmarks were similar in the two groups. CONCLUSIONS: The surgery-first orthognathic approach without presurgical orthodontic treatment treated facial asymmetry, possibly suggesting a possible paradigm shift in treatment. In addition, artificial intelligence-based cephalometric analysis was an effective tool. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Depressive symptoms, chronic medical illness, and health care utilization: findings from the Korean Longitudinal Study of Ageing (KLoSA).

BACKGROUND: This population-based study examined the relative and combined relationships of chronic medical illness (CMI) and depressive symptoms with health care utilization among older adults in South Korea. METHODS: A nationally representative sample of 3224 older adults participating in the Korean Longitudinal Study of Ageing (KLoSA) were categorized into four groups based on clinical characteristics: CMI only; depressive symptoms only; CMI and depressive symptoms; and neither CMI nor depressive symptoms. We estimated the use of various health care services by the groups while adjusting for clinical and sociodemographic characteristics. RESULTS: Depressive symptoms, as measured by the short-form Center for Epidemiological Studies-Depression scale (CES-D10), were prevalent, often occurring together with CMI in community-dwelling older adults in South Korea. Having depressive symptoms was positively associated with the use of inpatient services, outpatient physician services, and public health centers. The odds of using health care services were larger among older people with both depressive symptoms and CMI than depressive symptoms only. CONCLUSIONS: Self-reported depressive symptoms and self-reported CMI are prevalent among older adults in South Korea, often occurring together and possibly increasing health care utilization. These findings imply a need for chronic disease management targeting older people with complex mental and medical conditions and evaluation of its effects on health outcomes and service use.

A decade of public long-term care insurance in South Korea: Policy lessons for aging countries.

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.

How and why do countries make Universal Health Care policies? Interplay of country and global factors.

BACKGROUND: An examination of country policy making tends to reveal more complex processes that reflect domestic as well as external pressures and influences. The paper examines the interplay of external and internal, as well as other, factors in universal health care (UHC) decision-making for a select number of countries spanning the income range from low to high income. METHODS: After developing a conceptual framework to help identify variables to explore in answering our study questions, we reviewed literature on health policies and policy making, especially around the time of the adoption of relevant policies for a number of UHC reform countries, followed by a narrative review of countries for more in-depth study. For more quantitative data, we consulted databases maintained by international institutions. RESULTS: We found that, for low-income countries (LICs)/lower-middle-income countries (LMICs), the external environment helps set the policy agenda that drives national priorities and resource allocation decisions, while national actors take the actual decisions consistent with the interests of their constituencies and their goals. The upper-middle-income countries (UMICs) and high-income countries (HICs) in the study were less influenced by externally driven agendas and more by their own internal dynamics. For LICs/LMICs, a country's income level as well as growth record did not appear to play any overt role at the start of the reform, whereas the UMIC/HIC countries were generally at a higher economic stage with steady growth when they initiated the reforms. The use of technical analysis and evidence to guide the UHC reform decisions was much more pronounced in the UMICs/HIC. The findings on alignment of the UHC program to national health priorities were more mixed. On sustainability, the UMICs/HIC were much more likely than LICs/LMICs to phase in their reforms, whether in terms of the geographical extension of coverage, the population groups to be covered or the expansion of the benefit package in the course of time. CONCLUSIONS: The near-systematic use of scientific evidence by the UMICs/HIC to inform decisions on the path to UHC in contrast to the LICs/LMICs leads to the conclusion that some LICs/LMICs may have made less than optimal resource allocation decisions based on scanty evidence and factors not conducive to sustainability of their UHC efforts.

Universal health care in middle-income countries: Lessons from four countries.

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.

Surgery-first orthognathic approach for the correction of facial asymmetry.

We aimed to compare the reliability of the surgery-first approach and the traditional orthodontic-first approach for the correction of facial asymmetry based on the new classification of facial asymmetry. Patients with facial asymmetry who underwent orthognathic surgery between January 2016 and January 2019 were included. Cephalometric changes and relapse ratios were analyzed 12 months before and after surgery. Patients were divided into horizontal and vertical asymmetry groups based on the asymmetry vector, and subgroup analysis was conducted. The surgery-first approach without presurgical orthodontic treatment and the orthodontic-first approach showed a similar degree of asymmetry correction and skeletal stability. The relapse ratios of the maxilla height in the surgery-first and orthodontic-first groups were 0.25 ± 0.21 and 0.27 ± 0.25, respectively (p = 0.63), the relapse ratios of the maxilla width were 0.31 ± 0.32 and 0.21 ± 0.2, respectively (p = 0.14), the mandibular height relapse ratios were 0.34 ± 0.58 and 0.29 ± 0.36, respectively (p = 0.69), and the mandibular width relapse ratios were 0.12 ± 0.22 and 0.26 ± 0.31, respectively (p = 0.058). The treatment period of the surgery-first group (18.5 ± 5.3 months) was significantly shorter than that of the orthodontic-first group (22.9 ± 7.5 months, p = 0.024). Among the surgery-first group, patients with vertical asymmetry (15.0 ± 3.2 months) had a shorter treatment than those with horizontal asymmetry (21.6 ± 6.8 months, p = 0.006). Although contesting traditional standards is always challenging, the surgery-first orthognathic approach may lead to a new era in traditional orthognathic approaches. This new classification of facial asymmetry could be useful and practical when treating patients with facial asymmetry regardless of the etiology.

Systematic assessment of South Korea's capabilities to control COVID-19.

South Korea's COVID-19 control strategy has been widely emulated. Korea's ability to rapidly achieve disease control in early 2020 without a "Great Lockdown" despite its proximity to China and high population density make its achievement particularly intriguing. This paper helps explain Korea's pre-existing capabilities which enabled the rapid and effective implementation of its COVID-19 control strategies. A systematic assessment across multiple domains demonstrates that South Korea's advantages in controlling its epidemic are owed tremendously to legal and organizational reforms enacted after the MERS outbreak in 2015. Successful implementation of the Korean strategy required more than just a set of actions, measures and policies. It relied on a pre-existing legal framework, financing arrangements, governance and a workforce experienced in outbreak management.

Assessing the impact of non-pharmaceutical interventions on the transmissibility and severity of COVID-19 during the first five months in the Western Pacific Region.

While most countries in the Western Pacific Region (WPR) had similar trajectories of COVID-19 from January to May, their implementations of non-pharmaceutical interventions (NPIs) differed by transmission stages. To offer a better understanding for an implementation of multidisciplinary policies in COVID-19 control, we compared the impact of NPIs by assessing the transmissibility and severity of COVID-19 in different phases of the epidemic during the first five months in WPR. In this study, we estimated the piecewise instantaneous reproduction number (R t ) and the reporting delay-adjusted case-fatality ratio (dCFR) of COVID-19 in seven WPR jurisdictions: Hong Kong Special Administrative Region, Japan, Malaysia, Shanghai, Singapore, South Korea, and Taiwan. According to the results, implementing NPIs was associated with an apparent reduction of the piecewise R t in two epidemic waves in general. However, large cluster outbreaks raised the piecewise R t to a high level. We also observed relaxing the NPIs could result in an increase of R t . The estimated dCFR ranged from 0.09% to 1.59% among the jurisdictions, except in Japan where an estimate of 5.31% might be due to low testing efforts. To conclude, in conjunction with border control measures to reduce influx of imported cases which might cause local outbreaks, other NPIs including social distancing measures along with case finding by rapid tests are also necessary to prevent potential large cluster outbreaks and transmissions from undetected cases. A comparatively lower CFR may reflect the health system capacity of these jurisdictions. In order to keep track of sustained disease transmission due to resumption of economic activities, a close monitoring of disease transmissibility is recommended in the relaxation phase. The report of transmission of SARS CoV-2 to pets in Hong Kong and to mink in farm outbreaks highlight for the control of COVID-19 and emerging infectious disease, the One Health approach is critical in understanding and accounting for how human, animals and environment health are intricately connected.