Factors Affecting the Preference for Hospitals Over Clinics in Primary Care in Korea.

BACKGROUND: While the effect of gatekeeping was extensively studied, few efforts have been made to explain why the measures to strengthen gatekeeping do not work well in some countries. This study examined the patient factors related to the choice of level of health care facilities for outpatient care in Korea. METHODS: We examined a population-based sample representative of the population of Korea aged 15 and over in the healthcare experience survey of 2021. A logistic regression model examined the factors associated with choosing hospitals or clinics for outpatient care. RESULTS: Easy accessibility, kindness of medical staff, and recommendations from acquaintances were considered more important for those who chose clinics over hospitals. While those who chose clinics were more likely to feel that physicians and nurses more readily communicated with patients, those who chose hospitals were more likely to feel that the facility was comfortable. Whereas those who chose hospitals were more likely to trust the current health care system in Korea, those who chose clinics were more likely to think that the health care system needed to be reformed. The tendency was similar when analyzed only among those with good perceived health conditions and without chronic diseases. CONCLUSION: This study demonstrates that the preference for hospitals over clinics is mainly based on desire rather than medical need and is not likely to be affected by measures intended to induce a voluntary change of behavior.

Depression and its associated factors: A comparison between congenital and acquired physical disabilities.

OBJECTIVE: While depression associated with disability has been extensively studied, how depression could differ depending on whether the disability is congenital or acquired remains to be investigated. The objective of this study was to compare depression and its related factors among people with congenital and acquired physical disabilities. METHODS: We used the 2016 Panel Survey of Employment for the Disabled in Korea, a population-based survey for people with disability registered with the Korean government. Among 4577 participants, a total of 2128 participants with physical disability were analyzed using Chi-square test and binary logistic regression analysis. RESULTS: The prevalence of depression was 12.9% in those with congenital physical disability and 16.0% in those with acquired physical disability. Stress due to disability and family relationship satisfaction were associated with higher and lower odds of depression, respectively, in both disability groups. Discrimination due to disability, divorce, social participation, and subjective social status were significant predictors of depression only in people with acquired disability. CONCLUSIONS: Compared to those with congenital disability, individuals with acquired disability can be more susceptible to issues relating to social relationship, social standing and discrimination. Findings of this study suggest that acquired disability and adapting to changes associated with it can be a source of mental distress in addition to living with it. More efforts are needed to address discrimination, provide supportive social relationships, and provide supportive living conditions in order to reduce depression in persons living with disability, especially those with acquired disability.

Factors Associated with End-Of-Life Health Care Use and Spending in Korea in Comparison with the General Population.

This study investigated the factors associated with end-of-life health care use and spending in Korea. Chronically ill decedents, who were hospitalized for one of nine chronic conditions during the year before death, were identified from the National Health Insurance Database in 2017. For comparison, the end-of-life care spending for all decedents and the annual health care spending for the general population were analyzed. The inpatient and outpatient end-of-life care spending for the chronically ill decedents were sixteen and seven times the annual inpatient and outpatient spending for the general population respectively. The regional income level was positively associated with both inpatient and outpatient spending among the decedents with a stronger association in the chronically ill decedents, while a negative association was found in the general population. No significant association was found between the inpatient spending and the number of hospital beds for the chronically ill decedents, whereas the number of beds in small to medium-sized hospitals was positively associated with inpatient spending for the total decedents and the general population. The findings suggest that hospitalization for end-of-life care depends more on the income of the patients, while the inpatient spending for total decedents and the general population are more likely to be affected by the supply of beds.

Factors associated with the rates of coronary artery bypass graft and percutaneous coronary intervention.

BACKGROUND: Korea has seen a rapid increase in the use of percutaneous coronary intervention (PCI) with the ratio of PCI to coronary artery bypass graft (CABG) the highest in the world. This study was performed to examine the factors associated with the rates of CABG and PCI. METHODS: The data were acquired from the National Health Insurance database in Korea in 2013. We calculated the age-sex standardized rates of CABG and PCI. We examined the factors associated with the CABG and PCI rates by performing a regression analysis. RESULTS: The rate of CABG showed a negative association with the deprivation index score, and other factors, such as the number of providers or hospital beds, did not show any significant association with the CABG rate. The rate of PCI had a strong negative association with the number of cardiothoracic surgeons and a strong positive association with the number of hospital beds. CONCLUSIONS: The positive association between the PCI rate and the number of hospital beds suggests that the use of PCI may be driven by the supply of beds, and the inverse association between the PCI rate and the number of cardiothoracic surgeons indicates the overuse of PCI due to lack of the providers of CABG. Policy measures should be taken to optimize the use of revascularization procedures, the choice of which should primarily be based on the patient's need.

Crimes by people with schizophrenia in Korea: comparison with the general population.

BACKGROUND: This study was performed to describe the prevalence of crimes committed by persons with schizophrenia using population-based data and to compare the crime prevalence of persons with schizophrenia and the general population. METHODS: The number of crimes was obtained from the Korean National Policy Agency (KNPA) crime statistics (2012-2016), which provide the number of crimes in terms of the criminal's mental status and mental health conditions. For the number of persons with schizophrenia, estimates were used which had been calculated from the inpatient and outpatient claims from the National Health Insurance Service. The crime prevalence in persons with schizophrenia was calculated according to the types of crimes, and a comparison with the general population was conducted. RESULTS: The overall crime prevalence of persons with schizophrenia was 72.7 to 90.3 per 10,000 from 2012 through 2016, which was about one fifth that of the general population. While the crime rates of the persons with schizophrenia were lower than the general population in most types of crimes including violence, intellectual crimes, and theft, the prevalence of murder, arson, and drug-related crimes in persons with schizophrenia was about five times, six times, and two times that of the general population respectively. CONCLUSION: The higher prevalence of serious offences among persons with schizophrenia suggests the need for closer and more appropriate care for the population, which would be achieved through effective continuity of institutional and community care.

An ecological study of geographic variation and factors associated with cesarean section rates in South Korea.

BACKGROUND: Korea is in a condition where the impact of patient and supplier factors on cesarean section rates can be clearly described. The cesarean section rates in Korea are among the highest in the world while the number of obstetricians is decreasing sharply. This study aimed to investigate the geographic variation in cesarean section rates in Korea and its factors. METHODS: The data were obtained from the National Health Insurance database in Korea in 2013. We calculated the age-standardized and crude cesarean section rates of 251 districts in Korea and variation statistics. A linear regression analysis was performed to determine factors for cesarean section rates. RESULTS: The overall cesarean section rate in Korea was 364.6 cases per 1000 live births. The deprivation index score was strongly associated with the increase in the cesarean section rate while the density of hospital obstetricians and hospital beds showed a negative association. Average maternal age and total fertility rate showed a negative relationship with the cesarean section rate. CONCLUSIONS: Korea is suffering from a continuing decrease in obstetricians. Our study shows that this decline has more of an effect on mothers in the disadvantaged areas. Securing equal access to obstetric care among areas is necessary, and measures to encourage obstetricians and mothers not to opt for cesarean section are required.

A spatial analysis of geographic variation and factors associated with hospitalization for bacterial pneumonia in Korea.

BACKGROUND: The incidence of pneumonia in Korea started to increase in the 1990's after a period of decrease and stabilization, and the mortality and hospitalization rates for pneumonia in Korea are alarmingly high. This study was performed to examine geographic variation and factors associated with hospitalization for bacterial pneumonia in Korea. METHODS: Data were acquired from the inpatient claims of the 2015 period of the National Health Insurance Service. The age- and sex-standardized hospitalization rates for bacterial pneumonia were calculated for three age groups. Geographic variation was measured with the coefficient of variation, the ratio of the 90th to the 10th percentile of the distribution of rates, and the systematic component of variation. Considering the results of Moran's I statistic which suggested spatial autocorrelation, we estimated spatial regression models using spatial error models. RESULTS: The hospitalization rate for bacterial pneumonia was 79.1 per 10,000 population, and the rate was the highest in the age group 0-14 at 325.3, and it was 161.5 among the elderly. The geographic variation statistics showed high variation with the coefficient variation at 0.6. The deprivation score showed positive associations, and the number of primary care physicians had a negative association with the hospitalization rates across all age groups but the age group 0-14. The number of beds in hospitals with less than 300 beds had a positive association with the hospitalization rates for bacterial pneumonia, and the impact was the strongest in the age group 0-14. CONCLUSIONS: The present study shows that pneumonia can be a major public health issue even in a developed country. Socioeconomic conditions can still be a concern for pneumonia in developed countries, and the role of primary care physicians in preventing hospitalization for bacterial pneumonia needs to be recognized. Most of all, the strong impact of hospital beds on the hospitalization rates for pneumonia, especially for the children, should be addressed. High disease burden of pneumonia in Korea can partly be attributable to oversupply of hospital beds. These factors should be taken into consideration in establishing policy measures for the rise in pneumonia.

Hospitalizations for ambulatory care sensitive conditions as an indicator of access to primary care and excess of bed supply.

BACKGROUND: Ambulatory care sensitive conditions (ACSC) hospitalization is a widely accepted measure of the access to primary care. However, given its discretionary characteristics, the ACSC hospitalization can be a measure reflecting the influence of hospital bed supply. In Korea, where the quality of primary care and oversupply of hospital beds are coexistent concerns, ACSC hospitalization can be used to examine the impact of both factors. This study was performed to investigate the ACSC hospitalization rate as a measure of the hospital bed supply as well as access to primary care. METHODS: Data were obtained from the National Health Insurance Database for 2015. We calculated the age-sex standardized hospitalization rates for ACSC in the total population and crude rates of ACSC hospitalization for three different age groups in 252 districts in Korea. We calculated the variation statistics of ACSC hospitalization rates, and we estimated a linear regression model to investigate the factors for ACSC hospitalization. RESULTS: There was a very high geographic variation in ACSC hospitalization rates. Higher density of primary care physicians was associated with a decreased ACSC hospitalization rate while a higher density of hospital beds in small to medium sized hospitals was associated with an increased rate. The deprivation index score had a strongly positive association with the ACSC hospitalization rates. CONCLUSION: ACSC hospitalization, while being a negative index of primary care access, can also be a measure indicating the impact of the hospital bed supply, and it is still a valid measure of the disparity of health care, the original motivation for this topic.

Geographic variation and factors associated with rates of knee arthroplasty in Korea-a population based ecological study.

BACKGROUND: The recent increase in knee arthroplasty (KA) use in Korea is among the highest in the world. The rapid increase in KA use suggests that the KA use in Korea could have been affected by medically unjustifiable factors. This study aimed to examine the geographic variation in the rate of KA and its associated factors in Korea. METHODS: We used the data from the National Health Insurance in Korea in 2013, from which a total of 67,086 claims for KA were obtained. We calculated the age-sex-standardized KA rates of the entire population and the crude rates of the age groups 0-64 and 65 and over in 251 districts. We assessed the geographic variation of the KA rates and examined the associated factors with a multivariate linear regression with the KA rate as a dependent variable. RESULTS: The overall rate of KA in Korea was 132.7 per 100,000 persons. The rates of KA showed a four-fold variation. The deprivation index score and the number of beds in the small to medium sized hospitals showed a positive association with the rates of KA while the number of orthopedic surgeons showed a negative association. CONCLUSIONS: Korea has been experiencing a rapid increase in the use of KA for the last decade or so, which was most prominent among the elderly population aged 65 and older. Our results suggest that the higher rate of KA is strongly related to a higher supply of beds and the socioeconomically deprived conditions. Considering that the decision concerning KA has room for discretion and also affects a considerable portion of health care expenditures, the use of KA should be thoroughly monitored with more emphasis on standardization in the decision making process and preventive measures that can lessen the need for KA.

Patient factors that affect trust in physicians: a cross-sectional study.

BACKGROUND: While trust in physicians has been rigorously investigated regarding its concept, measurement, and factors, the studies have mainly focused on the attributes of the physicians. This approach can lead to a limited understanding of trust in physicians as trust is based on the relationship, an interaction of both parties: patients and physicians. This study aimed to investigate the factors for trust in physicians among the Koreans by focusing on patients' traits which are related to their subjective perceptions. METHODS: A web-based survey was conducted between August and September 2016 among 1000 Korean adults aged 18 to 59 years. Survey participants were selected by a proportionate quota sampling based on age, sex and place of residence. The t-test and analysis of variance (ANOVA) were performed to examine the difference in trust in physicians among the different groups in each variable of patient characteristics. An ordinal logistic regression model was employed to examine the association between trust in physicians and patient attributes. RESULTS: Negative health-related traits, such as stress and low self-rated health, were likely to lower trust in physicians, and women were less likely to trust physicians. The negative attitudes toward the current health care system were strongly associated with low trust in physicians. Meanwhile, recent experience of hospitalization or outpatient visit was positively associated with trust in physicians, and experience of not being able to use health facilities showed no significant association. These results suggest that trust in physicians is more likely to be lowered by negative perception than by the objective conditions or experience. CONCLUSION: In investigating the factors for trust in physicians, the patients' predispositions, which make them less likely to trust physicians, should be considered. The attributes of the patients in Korea, which could negatively affect trust in physicians, need to be investigated in consideration of the recent changes in patient-physician relationships and the medical environment in Korea.

Associations of multicultural status with depressive mood and suicidality among Korean adolescents: the roles of parental country of birth and socioeconomic position.

BACKGROUND: The mental health of the offspring of immigrants is a major public health concern. In this study, we examined associations of multicultural status and parental country of birth with adolescent mental health in South Korea, and assessed the effect of socioeconomic position (SEP) on these associations. METHODS: We used four waves of the Korea Youth Risk Behavior Web-based Survey (KYRBS) between 2011 and 2014, including 294,324 participants (149,219 boys and 145,105 girls aged 13-18 years) as study subjects. KYRBS is a cross-sectional survey conducted annually by the Korea Centers for Disease Control and Prevention. The participants in the KYRBS were drawn as stratified multistage clustered samples from Korean middle schools and high schools. We calculated the age-adjusted 12-month prevalence of depressive mood and suicidal behaviors by parental country of birth, and estimated the effects of SEP indicators on the relationship. RESULTS: The age-standardized prevalence of suicidality (suicide ideation, plans, and attempts) was significantly different between multicultural and non-multicultural boys. The impact of multicultural status on mental health varied with parental foreign-born status and maternal country of birth. Compared with non-multicultural counterparts, boys with Japan-born mothers showed lower prevalence ratios (PRs) of suicidal plans (PR = 0.34, 95% CI 0.16-0.70). Girls with Japan-born mothers also showed lower PRs of depressive mood (PR = 0.77, 95% CI 0.63-0.95) and suicidal ideation (PR = 0.59, 95% CI 0.41-0.83), while adolescents with Korean-Chinese mothers showed similar PRs. Boys with foreign-born fathers as well as boys with two foreign-born parents were at a greater risk of suicidality than non-multicultural boys. The magnitude of the relationship between multicultural status and mental health outcomes was generally attenuated after adjusting for SEP indicators. CONCLUSIONS: In general, adolescents with Japan-born mothers showed lower PRs of depressive mood and suicidality than non-multicultural adolescents, while those with Korean-Chinese mothers showed similar PRs. Boys who had foreign-born fathers generally showed greater PRs of depressive mood and suicidality than non-multicultural boys. To ensure the effective implementation of policies to reduce mental health problems among multicultural adolescents in South Korea, detailed information should be considered regarding the cultural and socioeconomic backgrounds of families, such as parental country of birth and SEP.

The decrease in alcohol consumption and suicide rate during the COVID-19 pandemic and their association.

Despite the considerable change in alcohol consumption during the COVID-19 pandemic, the impact of the pandemic on the suicide rate in terms of alcohol consumption was not studied. This study was performed to examine whether the change in the suicide rate during the COVID-19 pandemic was related to alcohol consumption and whether the relation was specific to suicides when compared to mortality due to other causes. We performed a comparative interrupted time series (CITS) analysis for the suicide rate of people aged 19 to 60 with three comparison groups (the suicide rate of people aged 19 and under, the cancer death rate of people aged 19 to 60, and alcohol induced death rates). The suicide rate of people aged 19 to 60 and alcohol consumption per capita, along with alcohol induced death rates, continued to decrease during the pandemic in 2020 and 2021 while the suicide rate of people aged 19 and under and the cancer death rate showed an increase. In the comparative interrupted time series model, alcohol consumption had an increasing effect on the adult suicide rate compared to comparison groups when time trends and changes associated with COVID-19 were adjusted. This study shows that the decrease in adult suicide rate in Korea during the pandemic was associated with the decrease in alcohol use among the adult population. Considering that means restriction is the most effective way of controlling suicide and that alcohol can be the most potent and final trigger to suicide, the decrease in suicides during the pandemic and its association with alcohol consumption should be understood as a call for further efforts to decrease alcohol consumption.

The impact of the Mental Health Act revision for deinstitutionalization in Korea on the crime rate of people with schizophrenia.

This study examined changes in the crime rates of people with schizophrenia in Korea in comparison with the general population after the Mental Health Act revision for deinstitutionalization in 2017. The crime rates of people with schizophrenia and the general population were calculated from 2012 to 2021 using the Korean National Police Agency crime statistics. The effects of the law revision in 2017 on the crime rates were assessed using the interrupted time series and difference-in-difference analyses. The crime rates of people with schizophrenia tended to be lower than the general population except for murder and arson, which were 5.3 and 11.4 times, respectively, that of the general population. While no significant effect of the revision was found in the interrupted times series analysis, the difference-in-differences analysis indicated that the total crime rates and the rates of violence and public order crime increased among people with schizophrenia compared with the general population. The revision of the Mental Health Act for deinstitutionalization did not lead to an increase in the murder rate of people with schizophrenia as is commonly thought. However, the increases in overall crime and violence rates of people with schizophrenia suggest that the deinstitutionalized patients may not have been successfully relocated into the community. The increase in crime after the revision should be interpreted as a call for well-resourced community care rather than the reason for re-transfer of patients to hospitals.

The impact of the COVID-19 pandemic on suicides: A population study.

This study examines the factors associated with the change in the number of suicides per month during the COVID-19 pandemic from 2019 to 2021. For economic indicators, employment and unemployment rates, Consumer Price Index, and Consumer Sentiment Index were used. As inverse indicators of social distancing, the numbers of overseas departures, domestic trips, and movie audience were used. The monthly numbers of inpatients and outpatients for depression were included to consider the effect of the prevalence of depression. Pearson's correlation coefficient analysis and a linear regression were conducted. There was a continued decrease in the number of suicides of 1.7% in 2021 from 2020 following the 4.4% decrease in the previous year. The employment rate was positively associated with the number of suicides for males, while the consumer price index was negatively associated with the number of suicides for females. While the inverse social distancing measures were positively correlated with the number of suicides, no significant association was observed in the regression analysis. Commonly shared thoughts that the pandemic would lead to an increase in suicides by its direct negative impact on mental health or indirect impact through the aggravation of economic conditions and social distancing need to be re-examined.

Psychiatric hospitalization in Korea, 2011-2020: the impact of the Mental Health Act revision of 2017 in consideration of the COVID-19 pandemic.

OBJECTIVE: This study was performed to examine the changes in psychiatric hospitalization in Korea after the mental health law revision of 2017 with consideration of the COVID-19 pandemic. METHODS: The data were obtained from National Health Insurance and Medical Aid statistical yearbooks of 2011-2020. The changes in the inpatient and outpatient utilization for schizophrenia from 2011 to 2020 were compared with those for other psychiatric disorders and the general population. With difference-in-differences analysis, the changes in utilization of inpatient and outpatient care for schizophrenia after the law revision of 2017 were analyzed with two comparison groups. RESULTS: While the number of inpatients and inpatient days for schizophrenia decreased between 2017 and 2019, the number of outpatients and outpatient visits for schizophrenia increased during the period. Inpatient care utilization in two comparison groups increased during the same period. Whereas the COVID-19 pandemic of 2020 led to a general decrease in health care use among the population including inpatient care for schizophrenia, the number of outpatients for schizophrenia increased slightly after the pandemic. Difference-in-differences analysis showed that the law revision was associated with the decrease in the use of inpatient care for schizophrenia after adjustment for the effect of the COVID-19 pandemic. CONCLUSIONS: The mental health law revision in Korea led to a significant decrease in hospitalization for schizophrenia. However, the limited effect of revision on the Medical Aid beneficiaries suggests that the revision was not followed by the provision of the proper alternatives which can replace hospitalization of the most vulnerable population.

Suicide rates by occupation in Korea, 1993-2017: the impacts of financial crisis and suicide policy.

This study compared the suicide rates among different groups of occupations in Korea and their changes from 1993 through 2017. The suicide rate tended to be low in the high skill occupations except the manager group. The suicide rates showed increases around the financial crises of 1997 and 2008 in most occupations, and the sharpest increase was observed in the managers. The suicide rate in the manager group, which was the lowest among all occupation groups until the mid 2000s, showed the sharpest increase and became the highest since 2012 among all occupation groups. The sustained reduction in suicide rates among the skilled agricultural, forestry and fishery workers in Korea, following the implementation of paraquat control since 2005, shows that means restriction is an effective and essential way for reducing suicides. While more efforts should be put into means restriction, policy makers should focus on changing public perceptions of suicide in order that it would not be accepted as a possible solution for the difficulties in life.

Alcohol consumption and suicide rate: A cross-sectional analysis in 183 countries.

The age-standardized suicide rate and per capita alcohol consumption from 183 countries were acquired, and its relationship with per capita alcohol consumption was examined by the regression analysis. The positive associations between per capita alcohol consumption and the suicide rate were found among males and females in all income groups of countries. Compared with other environmental factors, controlling alcohol consumption has a distinct target and can be feasible and effective for reducing suicides. Health policy makers should keep in mind that alcohol consumption is costing lives not just by long-term physical ailments but also by making people vulnerable to suicide.

Comparison of the factors for suicidal ideation and suicide attempt: a comprehensive examination of stress, view of life, mental health, and alcohol use.

This study was performed to examine the elements that cause suicidal ideation to develop into a suicide attempt by comparing the factors related to suicidal ideation and attempt. The subjects in the study were 5982 employees, who received mental health screening from January 2016 to December 2019 in Korea. Multivariate binary logistic regression analysis was performed with suicidal ideation and suicide attempt as dependent variables respectively. While suicidal ideation was associated with both moderate and severe grades of depression and alcohol consumption, only severe grades of depression and alcohol consumption were associated with suicide attempts. Among family, interpersonal, work-related, and financial stress, which were significant predictors of suicidal ideation, only family stress predicted suicide attempts. Whereas dissatisfaction with the present, regret for the past, and hopelessness for the future were all predictors for suicidal ideation, only regret for the past was a significant predictor of suicide attempts. The distinctive impact of family stress on suicide attempts suggests that family support can play a pivotal role in suicide prevention, and the significant impact of regret for the past on suicide attempts indicates the need for a cognitive approach in a high-risk population. Finally, the substantial impact of alcohol on suicide attempts compared to suicidal ideation suggests the importance of alcohol regulation in suicide prevention.

Factors associated with the suicide rates in Korea.

The suicide rate in the Republic of Korea remains among the highest in the world, which needs to be examined in various aspects. This study investigated factors associated with the suicide rates in Korea. The suicide rates of 251 districts in Korea in 2015 and their relationships with the prevalence of heavy drinking, health care provision, and religion as well as demographic characteristics were examined with a Pearson correlations and a multiple linear regression analysis. The suicide rate in Korea was 26.5 per 100,000 persons in 2015. The regression analysis showed that the income level of the region, as represented by the average national health insurance premium, had a negative association with the suicide rate and that the prevalence of heavy drinking and the percentage of the population aged 65 and above had positive associations with the suicide rate. While the unemployment rate and the proportion of Catholics showed negative relationships with the suicide rate in the correlation matrix, the association was statistically insignificant in the regression analysis. Special attention should be given to excessive drinking and socio-economically disadvantaged conditions in taking measures to prevent suicide.

Regional Variation of Hospitalization Rates for Asthma in Korea: Association with Ambient Carbon Monoxide and Health Care Supply.

This study was performed to investigate the relationship between the hospitalization rate for asthma and the ambient carbon monoxide (CO) by examining regional variation of the hospitalization rates for asthma in Korea and its factors. The hospital inpatient claims for asthma were acquired from the National Health Insurance database in 2015. A multivariate linear regression was performed with the hospitalization rate for asthma as a dependent variable. The annual ambient concentration of CO showed a negative association with the hospitalization rates for asthma while that of sulfur dioxide showed a positive association. The number of primary care physicians showed a negative association with the hospitalization rates for asthma while the number of beds in hospitals with less than 300 beds showed a positive association. The negative association of the ambient concentration of CO with the hospitalization rates for asthma showed results upon further investigation.