Purpose: The purpose of this study is to identify the causes of the shortage of nurses in local small and medium-sized hospitals by confirming the wage status according to the characteristics of nurses and the characteristics of medical institutions and analyzing the factors affecting the wages of nurses.Methods: The study was conducted by linking the DB of medical institutions owned by the National Health Insurance Corporation, DB of medical personnel, and DB of health insurance qualification. As of the end of 2018, only nurses working at hospital-level medical institutions who were reported to the Health Insurance Review & Assessment Service were registered as registered members of the health insurance at the medical institution. The dependent variables were the monthly average wage of nurses, and the independent variables were age, institution establishment, medical institution type, region, and number of beds. In the analysis, first, wages by individual and institutional characteristics were identified through basic statistical analysis, and factors affecting wages were analyzed through regression analysis.Result: As a result, the wages of nurses increased 71,184 won as the age increased, and the establishment of medical institutions was 291,574 won less and corporations 660,725 won less than the national government. The types of medical institutions were 400,964 won less and 675,829 won less than general hospitals. The size of the city was 325,989 won less in metropolitan cities and 263,672 won less in metropolitan areas than in the metropolitan area. As the number of beds at medical institutions increased by one bed, it was 708 won higher.Conclusion: According to the analysis of the wage status according to the characteristics of nurses’ personal characteristics and medical institutions, and the wage determinants of nurses, the relatively low wages of nurses in local small and medium hospitals were the main cause of job shortage. The market principle is that the wage increases if there is a shortage of supply in the labor market compared to the demand of nurses. On the contrary, the wage is lower in local SMEs. As a result, there seems to be some nurses who give up their activities. In order to resolve the labor shortage in local small and medium-sized hospitals, it is necessary to narrow the wage gap, and to create a working environment such as elastic working so that the daily work can be balanced.
Purposes: It is known that medical institutions suffered substantial financial losses due to the COVID-19 pandemic, but studies that specifically identified the size of losses are lacking. This study aims to analyze in detail how much financial loss medical institutions suffered in 2020, at the beginning of the COVID-19 pandemic.Methodology: This study used national health insurance claim data from 2018 to 2020 provided by the Health Insurance Review and Assessment Service. Financial losses were conceptualized and classified as the increase or decrease in total medical expenses or the proportion of increased or decreased institutions. The trend of total medical expenses was analyzed by medical institution type, health insurance qualification type, and treatment type (inpatient/outpatient).Findings: The results showed that the decrease in medical expenses due to COVID-19 was the largest at clinic-level medical institutions, and the distribution of each clinic’s increases and decreases was wide. In addition, almost all of the pediatrics and otolaryngology clinics had a reduction in medical expenses due to COVID-19.Practical Implications: Medical institutions have been pleading about the pain caused by the COVID-19 pandemic. However, it was known that the decrease in total medical expenses in 2020 compared to 2019 was insignificant. This study overcame the trap of average through more detailed analyses, confirming the need for differentiated policy support in the event of a similar situation.
Objective: The large-scale spread of COVID-19 has led to a burden on the national healthcare financial system. This study assessed the medical cost of COVID-19 hospitalizations and its effect on national health expenditures in Korea and investigated the factors that affected the cost of hospitalization for COVID-19 patients.Methods: A total of 23,812 COVID-19 patients were reported as of September 30, 2020. 18,854 cases of COVID-19 hospitalization were claimed by The Health Insurance Review and Assessment Service with a total of 14,283 inpatients.Results: From January to September 2020, the total cost of treatment for hospitalized COVID-19 patients in Korea was 79,277,000 USD. The mean cost per case was 4,284 USD (IQR, 649-5,257). Medical costs were high in the elderly, those with severe symptoms, medical aid beneficiaries, and those who died during treatment. The mean length of hospital stay of COVID-19 patients was 17.3 days (IQR 9-23) and was high in women, the elderly, medical aid beneficiaries, and patients in Daegu and Gyeongsangbuk provinces. The differences in medical costs between sex, age, insurance, region, treatment result, and length of stay groups according to severity were significant for all variables. Moreover, the mean costs per case and per day were higher in medical aid beneficiaries than those subscribed to health insurance (PCOVID-19 patients was low compared to that of other countries, as well as the treatment cost for the H1N1 influenza in Korea. Factors affecting the medical cost of COVID-19 treatment included age, severity, type of insurance, and treatment results. Additional follow-up studies that also include the cost of screening and quarantine in the analysis of medical costs are necessary.
In the face of rapid aging in Korea, the demand for appropriate medical services for the elderly at home is increasing. This study investigates the current status of home medical care and Home health care in Korea based on the concept of Home-based primary care, and proposes strategies to implement home-care in public health centers and public hospitals that play a major role in the field of public health care.First of all, by presenting a conceptual framework for the current status of Korea’s home medical care and Home health care provision system, and described according to three financial resources: National Health Insurance(NHI), Long-Term Care Insurance(LTCI), and public health care. At the current level, the home health care systems are fragmented and they should be redesigned to improve the home care services.In order to implement home care in public health care institutions, a model centered on public health centers and public hospitals is proposed. Public health centers have various advantages, responsibility positions, and access to information, but they have working conditions and difficulties in providing incentives, and medical and nursing limitations. Public hospitals can provide a variety of services, but community access and insufficient knowledge are pointed out as disadvantages. Therefore, it is important to establish a cooperative system between the two institutions.Finally, we proposes the division and cooperation between public health centers and private medical institutions according to the level of service. Private medical institutions could be in charge of active treatment, medical services and skilled nursing cares. public health centers could perform monitoring and follow-up the patients. it is necessary to establish a coordinating system to cooperate the two parts of institutions.
Objective: Self-sufficiency Center is a organization which provide support for individual skill acquisition and work opportunities to beneficiaries of basic livelihood act. The goal of this study is to provide health care, customized counseling, and treatment at the community level to improve their health status.Methods: The subjects of this study were participants in three district self-sufficiency center of Seoul that received welfare funds in 2015 and 2016. All examinations included self-written surveys, body measurement, blood and urine tests, abdominal ultrasound and gastroscopy. Optional biopsy, colonocopy, lung CT and thyroid ultrasound were charged extra.Result: Through this examination, one case of colon cancer, two cases of cervical cancer, two cases of thyroid cancer and one case of lung cancer were found for malignant tumors. One case of internal carotid artery occlusion, one case of ascending aortic dilatation, three cases of hepatitis B antigen carrier and chronic liver disease, and diseases such as high blood pressure and dyslipidemia were newly diagnosed or found to be poorly controlled. Patients with all abnormal results were requested medical treatment with a specialist, and at least one year after the examination, approximately 45% of them found follow-up lost. In a retrospective telephone survey with 62 participants, they responded that they were not receiving medical treatment or health examinations because lack of time or cost. They responded that they will participate private health examinations again if economic support is provided.Conclusion: Through this private health examination whith people of low economic levels, it was confirmed that they were not in good health, but they have desire to do health examination and will voluntarily participate health examination if they have low economic burden. One clue to health inequality could be that people with low economic status are more likely to develop diseases due to cost burdens and neglect of health care.
Introduction: Task Forces to Support Public Health and Medical Services in Ulsan Metropolitan City (TSPMU) needs to establish a system for analyzing and collecting data on the public health status that can serve as the basis for local evidence-based projects and policy formulation. In order to engage citizens in this process, TSPMU has established an online panel (ULFAM) composed of Ulsan citizensMethods: In 2020, TSPMU planned the features to be implemented on the panel site by benchmarking similar sites. After a development period of approximately 5 months, the site was officially launched.Results: Currently, ULFAM has around 2600 Ulsan citizens as panel members. The panel site is organized into sections such as introduction to institution including vision, major projects, and information about affiliated organizations, as well as sections for survey participation and information board. Panel surveys are conducted through online questionnaires on the site. It also utilized as a means for recruiting participants. Various surveys have been conducted, including the Ulsan Medical Center establishment awareness survey, delivery workers’ health status survey, and more. The survey results are compiled into reports and used as foundational data for various projects. Additionally, the site is designed to link citizens to appropriate health and medical services based on the survey results. Furthermore, the panel is utilized for promotional activities related to Improvement of awareness regarding cancer screening and recognition of symptoms of cardiovascular diseases, and more. During these activities, collaboration with collaborating organizations has been undertaken, achieving a synergistic effect in promotion.Conclusion: The voluntary participation of residents in the field of public health is increasingly important. To implement effective policies, it is necessary to consider the opinions of the residents. ULFAM serves as a means of communication with Ulsan citizens, providing a platform for engaging with Ulsan residents on public health and medical issues in the community.
Objective: This study aimed to determine the current work environment and health conditions for delivery workers in Ulsan Metropolitan City.Methods: Data from 64 delivery workers were collected, including their sociodemographic and employment information, and their opinions on labor environment, health status, health check-ups, and national health services. Quantitative data were analyzed through frequency analysis to explore the results. Qualitative data, such as descriptive responses, were examined through a process of categorization and multi-frequency responses.Results: The primary risk exposure of delivery workers in workplace was vibration from machines, high temperatures enough to sweat even when not working, smoke, gas, dust, etc. (each at 50.0%). Physical threats during work included postures that caused fatigue or pain (76.6%) and direct interaction with people (76.6%). Challenges in welfare and support within the work environment included the lack of rest time or difficulty in utilizing it (60.9%), no regular mealtime (65.6%), and no provision of protective equipment by the company (57.8%). A total of 48.8% of delivery workers responded that there were health and safety risks in their work environment, and overall job satisfaction was low (59.4% expressed dissatisfaction). While the general health condition was good, there were numerous complaints of pain (79.7%). Specific health issues included upper limb muscle pain (70.3%), lower limb muscle pain (62.5%), and the most diagnosed disease was hyperlipidemia (23.4%). Over the past two years, 10.9% of the participants had not had health check-ups. 71.9% expressed their willingness to participate in health promotion services, followed by improvement in working conditions and the management of harmful substances, musculoskeletal disorders, and cardiovascular diseases.Conclusion: This study, by examining the health status of delivery workers in Ulsan Metropolitan City, provides valuable foundational data for improving their work environment and preventing occupational diseases among them.
Objective: Public hospitals play an important role in reducing health inequality among socially marginalized groups and local communities. The objective of this study was to investigate changes in healthcare utilization at public hospitals during the COVID-19 pandemic in Korea.Methods: The unit of analysis was public hospitals. This study adopted a retrospective longitudinal study design and used inpatient health insurance claim data from January 1, 2019 to December 31, 2020. In total, 206 public hospitals were analyzed. For statistical analysis, a generalized linear model using the number of health insurance claims was constructed.Results: The total number of patients who received COVID-19-related care was 44,949, with a length of stay (LOS) of 657,717 days. After controlling for hospital covariates, healthcare utilization at public hospitals decreased by 22.5% (relative risk [RR], 0.775; p=0.029) and 16.8% (RR, 0.832; p=0.045) for the actual number and total LOS of national health insurance patients, respectively. For beneficiaries of the Medical Aid program, the actual number and total LOS were reduced by 29.6% (RR, 0.704; p=0.001) and 35.8% (RR, 0.642; p=0.001), respectively. Interestingly, most of this reduction occurred at public hospitals providing general healthcare services.Conclusion: Despite significant changes in healthcare utilization, public hospitals played a critical role in providing healthcare regarding COVID-19. Healthcare policymakers need to pay more attention to the role of public hospitals in the next infectious disease pandemic.
Objective: In order to identify the status and factors of polypharmacy of elderly of medical aid, this study compared them with national health insurance.Methods: We established a cohort for the elderly using the Health insurance claim data of 2018. Polypharmacy is defined as the use of at least five concurrent medications for over 90 days annually. We compared the risk of polypharmacy by medical aid with that of national health insurance. To analyze the status of polypharmacy of medical aid and associated factors, and compare them with those of national health insurance, we conducted Chi-square test, t-test, and multivaiate logistic regression.Result: 46.4% of national health insurance and 67.8% of medical aid showed polypharmacy. After adjusting gender, age, comorbidity, Elixhauser Comorbidity Index (ECI) scores, and the number of outpatient visits, the odds ratio (OR) of polypharmacy was 1.80 (95% Confidence interval (CI), 1.79-1.82) times higher among medical aid. The number of prescriptions, the number of total prescribed medications a year, the number of daily average prescribed medications, and the cost of annual total prescribed medications are higher among medical aid. Major factors associated with polypharmacy were diabetes, cardio-cerebrovascular diseases, ECI of 2 points or higher, and at least 16 outpatient visits a year. The OR of medical aid aged 70~74 to those aged 65~69 was 0.88 (95%CI 0.86-0.90).Conclusion: To reduce the incidence of polypharmacy among elderly, a focus needs to be placed on patients with diabetes, cardio-cerebrovascular diseases and patients who visited outpatient at least 16 times a year. The medical aid need to be manage polypharmacy, regardless of severity and age. Efforts at the national level are needed to reduce the polypharmacy of the elderly of medical aid.
Objective: In this study, we wanted to check working conditions of public health care doctors(PHDs) working in unbridged island of korea.Methods: We made structured Self-administered questionnaire and sent to all of PHDs working in unbridged island and PHDs working in land as a controlled group.Result: 52 PHDs working in unbridged island and 130 PHDs working in land responded to our survey.PHDs working in unbridged island had difficulty using holiday, sick leave, and offical holiday to participate seminar. especially, difficult to use sick leave was statically significant(p<0.001). Almost all of them were working at night to coping with 24hr medical emergency, thus average overtime working hours was 214.8hr. However average overtime pay was 21.3hr and reward was not fully granted to them. Also, reward for COVID-19 related medical work(extracting COVID-19 specimen, medical examination before vaccination, epidemiological survey,prescription) were not fully payed (48.1%)as a wage guidelines given by the government. They suffered comparative deprivation from the other co-workers at same facility ,because of different working condition and duty. To cope with medical emergency, they required additional human resources with higher-level medical facility hotline(40.4%) and specialized medical emergency education(13.5%).Conclusion: A high percentage of PHDs working in unbridged island were first-year(92.5%),general practitioner or intern(69.2%), But they experienced high responsibility, low support and reward system early at their medical facility. So, policy making about appropriate reward and support system must be considered not only for PHDs working in unbridged island but also for primary health care system in korea.
