[Show abstract][Hide abstract] ABSTRACT: To date, studies have not comprehensively demonstrated the relationship between stroke incidence and socioeconomic status. This study investigated stroke incidence by household income level in conjunction with age, sex, and stroke subtype in Korea.
Contributions by the head of household were used as the basis for income levels. Household income levels for 21 766 036 people were classified into 6 groups. The stroke incidences were calculated by household income level, both overall within income categories and further by age group, sex, and stroke subtype. To present the inequalities among the six ranked groups in a single value, the slope index of inequality and relative index of inequality were calculated.
In 2005, 57 690 people were first-time stroke patients. The incidences of total stroke for males and females increased as the income level decreased. The incidences of stroke increased as the income level decreased in those 74 years old and under, whereas there was no difference by income levels in those 75 and over. Intracerebral hemorrhage for the males represented the highest inequality among stroke subtypes. Incidences of subarachnoid hemorrhage did not differ by income levels.
The incidence of stroke increases as the income level decreases, but it differs according to sex, age, and stroke subtype. The difference in the relative incidence is large for male intracerebral hemorrhage, whereas the difference in the absolute incidence is large for male ischemic stroke.
Journal of preventive medicine and public health = Yebang Ŭihakhoe chi. 03/2014; 47(2):104-12.
[Show abstract][Hide abstract] ABSTRACT: Purpose
Based on the Revised Nursing Work Index (NWI-R), this research aimed to develop a Korean Hospital General Inpatient Unit–Nursing Work Index (KGU-NWI). This study also aimed to compare the common points and differences between the subfactors of the KGU-NWI and the subfactors from previous studies.
Based on opinions from 3,151 nurses in Korean hospital general inpatient unit, this research used 57 items of NWI-R and the principal axis factor analysis for deriving subfactors. We evaluated the convergent validity through factor analysis and the content validity of KGU-NWI in terms of the association between nurses' job outcome and the subfactors derived.
Six subfactors and 26 items for KGU-NWI were derived from NWI-R. Among them, ‘physician-nurse relationship’, ‘adequate nurse staffing’ and ‘organizational support and management of hospital’ were the same with results from previous studies. In addition, two subfactors, ‘participation of decision-making processes’ and ‘education for improving quality of care’, which were similar with results from previous Korean studies, were newly added by using Korean hospital cases. In contrast to previous Korean studies, a unique subfactor this study found was ‘nursing processes’. This research confirmed that the six subfactors were highly correlated with job satisfaction, intention to leave, and quality of health care, which represented a nurse's job outcome.
KGU-NWI including six subfactors and 26 items is an applicable instrument to investigate nurse work environment in Korean hospital general inpatient unit.
Asian Nursing Research 01/2013; 7(3):128–135. · 0.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: This Study was to examine to applicability of the Maslach Burnout Inventory on measuring burnout of the nurses who works in Korean university hospitals. Methods: The sample included 200 nurses and nurse managers. We used 22-item Maslach Burnout Inventory to evaluate the reported burnout. We evaluated the convergent validity through the factor analysis, and evaluated the discriminant validity through the Pearson's correlation analysis. Also, we evaluated the reliability for three subscales of Maslach Burnout Inventory with the Cronbach's , which assesses the internal consistency. Results: Factor analysis revealed three factors being extracted from the 22-item Maslach Burnout Inventory, and item loading for each factor is higher than 0.5. Therefore, the Maslach Burnout Inventory demonstrated high convergent validity. Also, emotional exhaustion, personal accomplishment, and depersonalization showed low correlation leading to the conclusion that there was discriminant validity. The Cronbach's coefficients in the 22-item Maslach Burnout Inventory and three subscales were higher than 0.7. Conclusion: Maslach Burnout Inventory can be used as a valid instrument to measure the burnout level of the nurses working in Korean university hospitals.
[Show abstract][Hide abstract] ABSTRACT: This study explores income inequalities in the utilization of medical care by cancer patients in South Korea, according to type of medical facilities and survival duration. The five-year retrospective cohort study used data drawn from the Korean Cancer Registry, the National Health Insurance database, and the death database of the Korean National Statistical Office. The sample consisted of 43,433 patients diagnosed with cancer in 1999. The authors found significant quantitative inequalities as a function of income in the patients' utilization of medical care. Cancer patients from the highest income class used inpatient and outpatient care more frequently than did patients from the lowest income class. Those with higher incomes tended to use more inpatient and outpatient services at major tertiary hospitals, which were known as providing better medical care than other types of hospitals and clinics. Moreover, horizontal inequality in cancer-care expenditures favoring those with higher incomes was observed during earlier periods of treatment. In conclusion, income substantially affects the utilization of inpatient and outpatient services, amount of medical expenditures, and type of medical facilities.
International Journal of Health Services 01/2011; 41(1):51-66. · 1.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate inequalities in cancer incidence and mortality across income groups in South Korea.
After reviewing 2001 data from the Korean National Cancer Registry, and National Health Insurance and National Medical Aid data, 49,277 cancer cases were classified into six income groups. The incidence and 3-year mortality rates of major cancers were calculated separately and as a total.
Two composite indices (slope index of inequality and relative index of inequality) were calculated to analyse the relative differences in cancer incidence. The 3-year mortality rate ratios for major cancers were calculated, with Class 1 as the reference, using a Cox regression model to adjust for age.
The relative risk of cancer incidence (total) in the lowest income group was 1.65 and 1.43 times higher than that in the highest income group for males and females, respectively. For cancer mortality, all other income groups showed significantly higher 3-year mortality rate ratios than the highest income group for males and females.
This study identified inequalities in cancer incidence and 3-year mortality across income groups in South Korea, most of which were unfavourable to lower income groups. It is suggested that lower income groups should receive financial assistance for cancer screening and inpatient medical services.
Public Health 04/2008; 122(3):229-36. · 1.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There have been few studies examining the differences in health care utilization across social classes during the last year of life. Therefore, in this study we analyzed the quantitative and qualitative differences in health care utilization among cancer patients across educational classes in their last year of life, and derived from it implications for policy.
To evaluate health care utilization by cancer patients in the last year of life, Death certificate data from 2004 were merged with National Health Insurance data (n = 60,088). In order to use educational level as a social class index, we selected the individuals aged 40 and over as study subjects (n = 57,484). We analyzed the differences in the medical expenditures, admission days, and rates of admission experience across educational classes descriptively. Multiple regression analysis was conducted to evaluate the association between medical expenditures and independent variables such as sex, age, education class, site of death and type of cancer.
The upper educational class spent much more on medical expenditures in the last one year of life, particularly during the last month of life, than the lower educational class did. The ratio of monthly medical expenditures per capita between the college class and no education class was 2.5 in the last 6-12 months of life, but the ratio was 1.6 in the last 1 month. Also, the lower the educational class, the higher the proportion of medical expenditures during the last one month of life, compared to total medical expenditures in the last one year of life. The college educational class had a much higher rate of admission experiences in tertiary hospitals within Seoul than the other education classes did.
This study shows that the lower educational classes had qualitative and quantitative disadvantages in utilizing health care services for cancer in the last year of life.
Journal of Preventive Medicine and Public Health 02/2007; 40(1):36-44.
[Show abstract][Hide abstract] ABSTRACT: The disabled population is a vulnerable group, having very complex medical conditions, but little is known about differences in the level of access by type of disability. This study was performed to investigate the differences of health care utilization by the type of disability. The database was constructed from registry of the disabled and health insurance and medical aid claims data submitted to the Korea Health Insurance Cooperation during in the year 2003. The disability classified three groups according to the Disabled Welfare Act; physically disability with external dysfunction, physically disability with organic disease, and mentally disability. There were huge differences in health care utilization by the type of disability. For the inpatient care, those with a mental disability were more likely to utilize health care services in terms of average visit number of medical facilities and visit days per case, but the treatment amount per case was the highest in physically disabled with organic disease. For the outpatient care, those who the physically disabled with organic disease were more likely to utilize health care services in terms of average visit number of medical facilities, treatment amount per case, and the treatment days per case. Also, those who physically disabled with organic disease were more likely to utilize general hospital for both inpatient and outpatient care, and spent more out-of-pocket expenditure. As the number of persons with disabilities rises, the need to consider new approaches to protecting their health grows increasingly. Especially, Korean health care system should be refined to be more responsive to the needs of the type of disability.
[Show abstract][Hide abstract] ABSTRACT: Equity in health care services has been prioritized on the Korean government's policy agenda since the government-driven national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiaries. The purpose of this study is to identify disparities in the utilization of health care services, especially cancer inpatient services among different income groups in Jeju Island of South Korea. We analyzed the national health insurance data about qualification of beneficiaries and utilization of health care services consumed by Jeju Island's residents for 1 year of period (from January to December 2000) and acquired their utilization features of cancer inpatient services. The independent variable was 10 different income levels according to the national health insurance fee imposed on each household in 2000. The dependent variable was the volume of cancer inpatient services utilized, that was measured by admission days and costs for treatment. The utilization of cancer inpatient services in the 10 different income groups was analyzed in three geographical categories of medical institutions: (1) within Jeju Island; (2) outside Jeju Island; (3) South Korea in total. We calculated the concentration-indices of cancer inpatient services utilization in admission days and cost as a pair amongst these three geographical categories each. Both of the concentration-indices were negative for the category of 'within Jeju Island', positive for that of 'outside Jeju Island', and positive for that of 'South Korea in total'. These results suggest the relatively poor experience considerable inequality in the utilization of cancer inpatient services in Jeju Island, because lower income groups have higher incidence rates in most cancers and inevitably have more needs in health services.
Health Policy 06/2005; 72(2):187-200. · 1.55 Impact Factor