Dataset Information

Effects of a Dementia Screening Program on Healthcare Utilization in South Korea: A Difference-In-Difference Analysis.

ABSTRACT: To determine whether Seoul's dementia screening program increased the rate of diagnosis and the appropriate use of healthcare services for people with dementia, a retrospective data analysis was conducted based on administrative data from the Health Insurance Review and Assessment Service. Two cohorts were constructed to represent the year before Seoul's dementia screening program began (2007) (control group) and the year after the implementation of the program (2009) (treatment group). A difference-in-difference analysis was used to compare the diagnosis rates, number of clinic visits, and dementia-related drug prescription rates for 4 districts that implemented dementia screening programs between 2007 and 2009 and 14 areas that did not. After the introduction of the program, there was a 55.4% increase in physician-diagnosed dementia. The "average drug cost per patient" increased by 52.2% (Exp(?) = 1.522, p = 0.0264), the "average outpatient visits per patient" tended to increase by 13.5% (Exp(?) = 1.135, p = 0.1852), and the "average outpatient treatment fees per visit per patient" tended to increase by 24.4% (Exp(?) = 1.244, p = 0.0821). The implementation of dementia screening programs led to an increase in healthcare service utilization. Therefore, this program was found to be an effective strategy for reducing undiagnosed dementia cases and encouraging patients to use adequate healthcare services.

SUBMITTER: Lee SJ

PROVIDER: S-EPMC6843614 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Publications

Effects of a Dementia Screening Program on Healthcare Utilization in South Korea: A Difference-In-Difference Analysis.

Lee Su Jung SJ Seo Hyun-Ju HJ Lee Dong Young DY Moon So-Hyun SH

International journal of environmental research and public health 20191011 20

To determine whether Seoul's dementia screening program increased the rate of diagnosis and the appropriate use of healthcare services for people with dementia, a retrospective data analysis was conducted based on administrative data from the Health Insurance Review and Assessment Service. Two cohorts were constructed to represent the year before Seoul's dementia screening program began (2007) (control group) and the year after the implementation of the program (2009) (treatment group). A differ ...[more]

PMID: 31614513

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Project description:BackgroundPublic-private mix (PPM) programs on tuberculosis (TB) have a critical role in engaging and integrating the private sector into the national TB control efforts in order to meet the End TB Strategy targets. South Korea's PPM program can provide important insights on the long-term impact and policy gaps in the development and expansion of PPM as a nationwide program.Methods and findingsHealthcare is privatized in South Korea, and a majority (80.3% in 2009) of TB patients sought care in the private sector. Since 2009, South Korea has rapidly expanded its PPM program coverage under the National Health Insurance (NHI) scheme as a formal national program with dedicated PPM nurses managing TB patients in both the private and public sectors. Using the difference in differences (DID) analytic framework, we compared relative changes in TB treatment outcomes-treatment success (TS) and loss to follow-up (LTFU)-in the private and public sector between the 2009 and 2014 TB patient cohorts. Propensity score matching (PSM) using the kernel method was done to adjust for imbalances in the covariates between the 2 population cohorts. The 2009 cohort included 6,195 (63.0% male, 37.0% female; mean age: 42.1) and 27,396 (56.1% male, 43.9% female; mean age: 45.7) TB patients in the public and private sectors, respectively. The 2014 cohort included 2,803 (63.2% male, 36.8% female; mean age: 50.1) and 29,988 (56.5% male, 43.5% female; mean age: 54.7) patients. In both the private and public sectors, the proportion of patients with transfer history decreased (public: 23.8% to 21.7% and private: 20.8% to 17.6%), and bacteriological confirmed disease increased (public: 48.9% to 62.3% and private: 48.8% to 58.1%) in 2014 compared to 2009. After expanding nationwide PPM, absolute TS rates improved by 9.10% (87.5% to 93.4%) and by 13.6% (from 70.3% to 83.9%) in the public and private sectors. Relative to the public, the private saw 4.1% (95% confidence interval [CI] 2.9% to 5.3%, p-value < 0.001) and -8.7% (95% CI -9.7% to -7.7%, p-value <0.001) higher rates of improvement in TS and reduction in LTFU. Treatment outcomes did not improve in patients who experienced at least 1 transfer during their TB treatment. Study limitations include non-longitudinal nature of our original dataset, inability to assess the regional disparities, and verify PPM program's impact on TB mortality.ConclusionsWe found that the nationwide scale-up of the PPM program was associated with improvements in TB treatment outcomes in the private sector in South Korea. Centralized financial governance and regulatory mechanisms were integral in facilitating the integration of highly diverse South Korean private sector into the national TB control program and scaling up of the PPM intervention nationwide. However, TB care gaps continued to exist for patients who transferred at least once during their treatment. These programmatic gaps may be improved through reducing administrative hurdles and making programmatic amendments that can help facilitate management TB patients between institutions and healthcare sectors, as well as across administrative regions.

Project description:BackgroundTransportation costs can be a barrier to healthcare services, especially for low-income, disabled, elderly, and geographically isolated populations. This study aimed to estimate the transportation costs of healthcare service utilization and related influencing factors in Korea in 2016.MethodsTransportation costs were calculated using data from the 2016 Korea Health Panel Study. A total of 14,845 participants were included (males, 45.07%; females, 54.93%), among which 2,148 participants used inpatient and 14,787 used outpatient care services. Transportation costs were estimated by healthcare types, transportation modes, and all disease and injury groups that caused healthcare service utilization. The influencing factors of higher transportation costs were analyzed using multivariable regression analysis.ResultsIn 2016, the average transportation costs were United States dollars (USD) 43.70 (purchasing power parity [PPP], USD 32.35) per year and USD 27.67 (PPP, USD 20.48) per visit for inpatient care; for outpatient case, costs were USD 41.43 (PPP, USD 30.67) per year and USD 2.09 (PPP, USD 1.55) per visit. Among disease and injury groups, those with neoplasms incurred the highest transportation costs of USD 9.73 (PPP, USD 7.20). Both inpatient and outpatient annual transportation costs were higher among severely disabled individuals (inpatient, +USD 44.71; outpatient, +USD 23.73) and rural residents (inpatient, +USD 20.40; outpatient, +USD 28.66). Transportation costs per healthcare visit were influenced by healthcare coverage and residential area. Sex, age, and income were influencing factors of higher transportation costs for outpatient care.ConclusionTransportation cost burden was especially high among those with major non-communicable diseases (e.g., cancer) or living in rural areas, as well as elderly, severely disabled, and low-income populations. Thus, there is a need to address the socioeconomic disparities related to healthcare transportation costs in Korea by implementing targeted interventions in populations with restricted access to healthcare.

Dataset Information

Effects of a Dementia Screening Program on Healthcare Utilization in South Korea: A Difference-In-Difference Analysis.

Publications

Effects of a Dementia Screening Program on Healthcare Utilization in South Korea: A Difference-In-Difference Analysis.

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