Chang-Yup Kim

Is precarious employment damaging to self-rated health? Results of propensity score matching methods, using longitudinal data in South Korea

We aimed to evaluate the health effects of precarious employment based on a counterfactual framework, using the Korea Labor and Income Panel Survey data. At the 4th wave (2001), information was obtained on 1991 male and 1378 female waged workers. Precarious work was defined on the basis of workers employed on a temporary or daily basis, part-time, or in a contingent (fixed short-term) job. The outcome was self-rated health with five response categories. Confounding factors included age, marital status, education, industry and occupation of current employment, household income, residential area, and prior health status. Propensity scores for each individual to be a precarious worker were calculated from logistic models including those covariates, and based on them, precarious workers were matched to non-precarious workers. Then, we examined the effects of precarious employment on health and explored the potential intermediary variables, using ordered logistic Generalized Estimating Equations models. All analyses were performed separately by gender. Precarious workers were found to be in a lower socioeconomic position and to have worse health status. Univariate matched analyses showed that precarious employment was associated with worse health in both men and women. By further controlling for socio-demographic covariates, the odds ratios were attenuated but remained significant. Job satisfaction, especially as related to job insecurity, and monthly wage further attenuated the effects. This suggests that to improve health status of precarious workers in Korea, policy strategies need to tackle the channeling of the socially disadvantaged into precarious jobs. Also, regulations to eliminate discrimination against precarious workers in working conditions or material reward should be introduced and enforced. There is no doubt that job insecurity, which is pervasive among workers in Korea, should be minimized by suspending market-oriented labor policies which rely on quantitative flexibility.

Prevalence Estimation of Dementia in a Rural Area of Korea

OBJECTIVES: A cross‐sectional survey was conducted to estimate prevalence of dementia and to determine factors related to dementia among residents in a rural area, Yonchon county, Korea, in 1993.

Association between childhood fatal injuries and socioeconomic position at individual and area levels: a multilevel study

Objectives: To simultaneously examine the effects of area-level and individual-level socioeconomic position on fatal injuries in children <5 years of age. Methods: A retrospective cohort study based on the national birth and death registers of Korea. 2 667 060 children born during 1995–8 were followed up from birth to the 5th birthday. Cumulative incidences of fatal injuries were calculated, and through multilevel Poisson regression models, relative risks (RRs) of incidence rate were estimated according to children’s sex, father’s occupation and mother’s education at individual level, and deprivation and degree of urbanity at area level. Results: Girls had lower risk for fatal injuries than boys (RR 0.81; 95% confidence interval (CI) 0.75 to 0.87). Compared with children with fathers in non-manual occupations, those with fathers in manual (RR 1.45; 95% CI 1.34 to 1.58) or other occupations (RR 1.35; 95% CI 1.13 to 1.62) had higher risk. Children with mothers who were high school graduates (RR 1.23; 95% CI 1.12 to 1.36) or junior school graduates (RR 1.91; 95% CI 1.66 to 2.19) had higher risk than those whose mothers were college graduates. After controlling for individual-level variables, residence in more deprived districts (RR 1.13; 95% CI 1.05 to 1.21) or non-metropolitan regions (urban RR 1.34; 95% CI 1.22 to 1.47 and rural RR 1.61; 95% CI 1.40 to 1.86) was significantly associated with increased risk. Conclusions: Both individual-level and area-level socioeconomic position influenced the risk for childhood fatal injuries. To reduce the socioeconomic inequalities and the absolute burden in Korea, universal strategies should receive priority, and special efforts in implementation should be directed towards both disadvantaged households and areas.

Validation of the International Classification of Diseases 10th Edition-based Injury Severity Score (ICISS)

OBJECTIVE To compare the predictive power of International Classification of Diseases 10th Edition (ICD-10)-based International Classification of Diseases 9th Edition-based Injury Severity Score (ICISS) with Trauma and Injury Severity Score (TRISS) and ICD-9CM-based ICISS in the injury severity measure. METHODS ICD-10 version of survival risk ratios was derived from 47,750 trauma patients from 35 emergency centers for 1 year. The predictive power of TRISS, the ICD-9CM-based ICISS and ICD-10-based ICISS were compared in a group of 367 severely injured patients admitted to two university hospitals. The predictive power was compared by using the measures of discrimination (disparity, sensitivity, specificity, misclassification rates, and receiver operating characteristic curve analysis) and calibration (Hosmer-Lemeshow goodness-of-fit statistics), all calculated by logistic regression procedure. RESULTS ICD-10-based ICISS showed a lower performance than TRISS and ICD-9CM-based ICISS. When age and Revised Trauma Score were incorporated into the survival probability model, however, ICD-10-based ICISS full model showed a similar predictive power compared with TRISS and ICD-9CM-based ICISS full model. ICD-10-based ICISS had some disadvantages in predicting outcomes among patients with intracranial injuries. However, such weakness was largely compensated by incorporating age and Revised Trauma Score in the model. CONCLUSION The ICISS methodology can be extended to ICD-10 horizon as a standard injury severity measure in the place of TRISS, especially when age and Revised Trauma Score were incorporated in the model. For patients with intracranial injuries, the predictive power of ICD-10-based ICISS was relatively low because of differences in the classifying system between ICD-10 and ICD-9CM.

Who wants to enter a long-term care facility in a rapidly aging non-western society? Attitudes of older koreans toward long-term care facilities

To estimate future demand for institutional long‐term care (LTC) by Koreans, the intention to use LTC facilities was estimated, and the underlying influencing factors were explored. Data from the Korean National Survey of LTC Need in the Elderly compiled in 2001 were used, and 1,850 people aged 65 and older who were classified as the targets for LTC in the survey and for whom complete data were available were sampled. The following influencing variables were selected based on Andersons service‐use model: demographics, social structural factors, family and community resources, and felt and assessed needs. The result shows that, of all the participants, 18.8% intended to use LTC facilities. A stronger intention was related to younger age, Christian religion, fewer children, lower family income, higher chronic comorbidity, and more education. The rapid industrialization of Korea has lead to a transition from the traditional family‐centered mode of caregiving to a nontraditional one, but the intention to use LTC facilities is still lower than in Western developed countries. Regarding family resources, the effect of extended families comprising three or more generations is not as significant as expected, but children continue to be regarded as the main resources for LTC. The recent introduction of nontraditional religions to Korea has had a positive effect on intention to use LTC facilities, suggesting that cultural factors influence their use.

Contribution of income-related inequality and healthcare utilisation to survival in cancers of the lung, liver, stomach and colon

Objectives To examine differences in the survival rates of cancer patients according to socioeconomic status, focusing on the role of the degree of healthcare utilisation by the patient. Methods An observational follow-up study was done for 261 lung cancer, 259 liver cancer, 268 stomach cancer and 270 colon cancer patients, diagnosed during 1999–2002. Income status and healthcare utilisation were assessed with National Health Insurance (NHI) data; survival during 1999–2002 was identified by death certificate. HRs and 95% CI were derived from Cox proportional hazards regression. Results and Conclusions The HRs for low income status are larger for colon cancer (2.37, 95% CI 1.17 to 4.80), followed by stomach (1.67, 95% CI 1.01 to 2.78), liver (1.57, 95% CI 1.03 to 2.39) and lung cancers (1.46, 95% CI 0.99 to 2.14). In the model including the variable of healthcare utilisation, colon and stomach cancers exhibited a lower HR in the moderate healthcare utilisation groups (0.40, 95% CI 0.21 to 0.76 in colon; 0.59, 95% CI 0.37 to 0.96 in stomach), whereas for liver cancer, the high utilisation group exhibited a higher hazard (1.72, 95% CI 1.07 to 2.75). A lower income status is independently related to a shorter survival time in cancer patients, especially in less fatal cancers. Healthcare utilisation independently affects the likelihood of survival from colon and stomach cancers, implying that a moderate degree of healthcare utilisation contributes to a longer survival time.

Modernized education of traditional medicine in Korea: is it contributing to the same type of professionalization seen in Western medicine?

In Korea, the teaching of traditional medicine (TM) has been institutionalized for more than five decades, and accordingly the formulated educational system has a structure similar to that of Western medicine (WM). The authors therefore assumed that TM and WM students would share similar attitudes and values regarding professionalism. To test this hypothesis, we administered a questionnaire to TM students nationwide, and compared the results with those of WM students. We found that, despite the large differences in philosophy, concepts, and clinical content between the medical disciplines, the professional socializations of TM and WM students were progressing in a similar way.

Health technology assessment in South Korea

OBJECTIVE To analyze evolution of the health technology assessment (HTA) at the national level in South Korea. METHODS Analysis of public documents, personal communication, and literative review. RESULTS HTA in South Korea has been developed since 1990s, first introduced by academia and institutionalized within the National Health Insurance (NHI). Rapidly increasing expenditure had been a challenge of the NHI, which considered health technology management as a cost controlling measure. An amendment was made to the NHI Law in 2000, and provision was made to regulate the process of determining new insurance benefits including procedures, drugs, and equipment. This requirement made the NHI agencies to promote HTA approaches in connection with the government and professional organizations. Also the Healthcare Act was revised in October 2006 ruling that HTA focusing on safety and effectiveness be responsible for new health technologies. Currently, the HTA process is governed by a governmental committee comprising twenty members and technically supported by the HTA center created in the NHI structure. CONCLUSIONS Institutionalized HTA in Korea has been driven mainly by the requirements of the NHI and manifested strengths as well as weaknesses. The government is establishing a new organization for HTA, independent from the NHI.

Are league tables controlling epidemic of caesarean sections in South Korea

Objective  To assess the impact of the publication of hospital caesarean section rates on the reduction of these rates in South Korea, and explore associated factors contributing to the decrease.

Early stage evolution of a hospital information system in a middle income country: a case study of korea

The purpose of this research was to understand the adoption trend of hospital information systems (HIS) in Korea. Our main interest was when hospitals adopted each component of HIS and how they expanded the system. A telephone survey with structured questionnaires was performed in the department of HIS in each hospital. As of 1998, 276 hospitals had been contacted with a response rate of 93.5%;. Hospital information systems have been introduced rapidly since the early 1990s and mainly focused on business and financial systems, patient management systems (PMS) and management information systems (MIS). From the mid-1990s, HIS has been developed to include medical record management systems (MRS), order communication systems (OCS), laboratory information systems (LIS), and picture archiving and communication systems (PACS). Recently Korean hospitals have adopted HIS in the following order of magnitude: PMS, MIS, MRS, OCS, LIS and PACS.