We sought to assess continuity of care for elderly patients in Korea and to examine any association between continuity of care and health outcomes (hospitalization, emergency department visits, health care costs). This was a retrospective cohort study using the Korea National Health Insurance Claims Database. Elderly people, 65-84 yr of age, who were first diagnosed with diabetes mellitus (n=268,220), hypertension (n=858,927), asthma (n=129,550), or chronic obstructive pulmonary disease (COPD, n=131,512) in 2002 were followed up for four years, until 2006. The mean of the Continuity of Care Index was 0.735 for hypertension, 0.709 for diabetes mellitus, 0.700 for COPD, and 0.663 for asthma. As continuity of care increased, in all four diseases, the risks of hospitalization and emergency department visits decreased, as did health care costs. In the Korean health care system, elderly patients with greater continuity of care with health care providers had lower risks of hospital and emergency department use and lower health care costs. In conclusion, policy makers need to develop and try actively the program to improve the continuity of care in elderly patients with chronic diseases.
Aged ; Aged, 80 and over ; Asthma/*economics ; Cohort Studies ; Continuity of Patient Care/*economics ; Costs and Cost Analysis ; Databases, Factual ; Diabetes Mellitus/*economics ; Emergency Service, Hospital/economics ; Female ; Hospitalization/economics ; Humans ; Hypertension/*economics ; Male ; National Health Programs ; Pulmonary Disease, Chronic Obstructive/*economics ; Republic of Korea ; Retrospective Studies ; Risk

OBJECTIVES: The objectives of this study were to estimate the continuity of care for all Koreans with diabetes and to identify factors affecting the continuity of care. METHODS: We obtained National Health Insurance claims data for patients with diabetes who visited health-care providers during the year 2004. A total of 1,498,327 patients were included as study subjects. Most Frequent Provider Continuity (MFPC) and Modified, Modified Continuity Index (MMCI) were used as indexes of continuity of care. A multiple linear regression analysis was used to identify factors affecting continuity of care. RESULTS: The average continuity of care in the entire population of 1,498,327 patients was 0.89+/-0.17 as calculated by MFPC and 0.92+/-0.16 by MMCI. In a multiple linear regression analysis, both MFPC and MMCI were lower for females than males, disabled than non-disabled, Medicaid beneficiaries than health insurance beneficiaries, patients with low monthly insurance contributions, patients in rural residential areas, and patients whose most frequently visited provider is the hospital. CONCLUSIONS: The continuity of care for patients with diabetes is high in Korea. However, women, the disabled and people of low socio-economic status have relatively low continuity of care. Therefore, our first priority is to promote a diabetes management program for these patients.
Poverty ; National Health Programs ; Middle Aged ; Medical Assistance ; Male ; Linear Models ; Korea/epidemiology ; Insurance Claim Review ; Humans ; Female ; Diabetes Mellitus/economics/epidemiology/*therapy ; Continuity of Patient Care/economics/*statistics & numerical data ; Aged ; Adult

PURPOSE: This study examined the predictive factors enabling access to children's oral health care at the level of financial barriers, beliefs, and the provider. METHODS: In-depth interviews were conducted with 320 immigrant mothers of low-income families regarding their use of oral health services for children aged four to eight years old. Access to oral health care was measured with frequency of planned dental visits, continuity of care, and age at first visit to dentist. RESULTS: The mother took her child to the dentist at a younger age if she received referrals to a dentist from pediatrician. Regular dental visits were significantly related to household income, provider availability on weekends, and insurance coverage. The extended clinic hours in the evenings, and the belief in the importance of the child's regular dentist visits increased the likelihood of continuing care. The mothers perceiving a cost burden for the child's dental care were also less likely to return to the dentist. CONCLUSION: The available care delivery system, coordinated medical care, and health beliefs were among important predictors of the health service use. The study findings suggest need for culturally competent dental health interventions to enhance access to oral health care among particularly vulnerable populations such as low-income children in Korean communities.
Adult ; Attitude to Health/*ethnology ; Chicago ; Child ; Child, Preschool ; Clinical Competence/standards ; Continuity of Patient Care/standards ; Cultural Diversity ; Dental Care for Children/economics/*utilization ; Emigration and Immigration ; Female ; Focus Groups ; Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Health Services Accessibility/standards ; Health Services Needs and Demand ; Hispanic Americans/education/*ethnology ; Humans ; Mexico/ethnology ; Mothers/education/*psychology ; Multivariate Analysis ; Nursing Methodology Research ; Poverty/economics/*ethnology ; Puerto Rico/ethnology ; Questionnaires