1.Evidence of a Broken Healthcare Delivery System in Korea: Unnecessary Hospital Outpatient Utilization among Patients with a Single Chronic Disease Without Complications.
Jin Yong LEE ; Min Woo JO ; Weon Seob YOO ; Hyun Joo KIM ; Sang Jun EUN
Journal of Korean Medical Science 2014;29(12):1590-1596
This study aims to estimate the volume of unnecessarily utilized hospital outpatient services in Korea and quantify the total cost resulting from the inappropriate utilization. The analysis included a sample of 27,320,505 outpatient claims from the 2009 National Inpatient Sample database. Using the Charlson Comorbidity Index (CCI), patients were considered to have received 'unnecessary hospital outpatient utilization' if they had a CCI score of 0 and were concurrently admitted to hospital for treatment of a single chronic disease - hypertension (HTN), diabetes mellitus (DM), or hyperlipidemia (HL) - without complication. Overall, 85% of patients received unnecessary hospital services. Also hospitals were taking away 18.7% of HTN patients, 18.6% of DM and 31.6% of HL from clinics. Healthcare expenditures from unnecessary hospital outpatient utilization were estimated at: HTN (94,058 thousands USD, 38.6% of total expenditure); DM (17,795 thousands USD, 40.6%) and HL (62,876 thousands USD, 49.1%). If 100% of patients who received unnecessary hospital outpatient services were redirected to clinics, the estimated savings would be 104,226 thousands USD. This research proves that approximately 85% of hospital outpatient utilizations are unnecessary and that a significant amount of money is wasted on unnecessary healthcare services; thus burdening the National Health Insurance Service (NHIS) and patients.
Chronic Disease/*economics/*epidemiology/therapy
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Comorbidity
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Delivery of Health Care/economics/utilization
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Health Care Costs/*statistics & numerical data
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Humans
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Outpatient Clinics, Hospital/*economics/*utilization
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Patient Admission/economics/statistics & numerical data
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Prevalence
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Republic of Korea/epidemiology
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Unnecessary Procedures/*economics/*utilization
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Utilization Review
2.Drug Utilization Review.
Journal of the Korean Medical Association 2004;47(2):156-162
Drug utilization review (DUR) is one of the approaches to improve quality of health care and reduce its costs. DUR programs have been defined as "structured, ongoing initiatives that interpret patterns of drug use in relation to predetermined criteria, attempting to prevent or to minimize inappropriate prescribing while maximizing the effectiveness of drug therapy to save costs." There have been a limited number of papers to evaluate the economic consequences of DUR programs, and they provide no definite evidence regarding the cost saving or costeffectiveness of the programs. A possible explanation for this would be that DUR might not be awarded a high priority, resulting in reduced opportunities for financing to DUR including development of a good program and its evaluation study. However, despite these problems, in Korea simple descriptive studies of drug utilization and the development of effective intervention strategies must start and continue in order to optimize drug therapy and to save costs in health care. Pharmacoeconomic studies are employed to measure drug efficiencies, through comparison of the costs and effects of alternative therapies. Theses studies can uncover the economics repercussions of inappropriate prescribing and quantify the cost effectiveness of various DUR interventions. The use of DUR in conjunction with pharmacoeconomic analysis will result in more costeffective and rational utilization of medicines. Both methods could be used in a complementary fashion. In conclusion, DUR processes will lead to the better utilization of drugs, based on improved economic and social performance.
Awards and Prizes
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Complementary Therapies
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Cost Savings
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Cost-Benefit Analysis
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Delivery of Health Care
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Drug Therapy
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Drug Utilization Review*
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Drug Utilization*
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Economics, Pharmaceutical
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Inappropriate Prescribing
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Korea
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Quality of Health Care
3.Study on the equity of rural health service in the experimental region of new rural cooperative medical scheme, Yuexi county, Anhui province.
Dong-Qing YE ; Yi-Lin HE ; Li MA ; Ai-Xiang HU
Chinese Journal of Epidemiology 2006;27(11):934-938
OBJECTIVETo explore the situation of equity in health service delivery in the experimental region of new rural cooperative medical scheme (NRCMS).
METHODSA household questionnaire survey was conducted to 2112 residents in the experimental county of NRCMS in Yuexi county with a stratified-cluster sampling on the situation of health service delivery, from July 1-15,2005. Data was analyzed with Epi Info 6.04 and SPSS 11.0 software and indices as rate, ratio, Gini coefficient, concentration index (CI) and chi-square test etc.
RESULTSThere was no significante difference of the treatment-seeking rate during two weeks among five groups economic condition residents (chi2 = 5.52, P > 0.05) and the rates were 48.14 per thousand, 82.90 per thousand, 65.88 per thousand, 48.72 per thousand and 50.66 per thousand respectively with CI = -0.026. Similarly, the hospitalization rates were 59.08 per thousand, 67.36 per thousand, 51.76 per thousand, 58.97 per thousand and 52.86 per thousand respectively in the last year and the CI = - 0.017. But there was a significante difference of rates on chronic disease among the five groups of residents with different economic conditions in the last six months (chi2 = 18.42, P < 0.01) and the rates were 295.40 per thousand, 243.52 per thousand, 230.59 per thousand, 225.64 per thousand and 176.21 per thousand and the CI = -0.055. When income reduced, the prevalence had been increasing among residents. Meanwhile, the collection funds showed unfair in residents with various income and the compensating fund of new rural cooperative medical scheme had not reduced the gap between rich and poor.
CONCLUSIONThere was an unequity of medicine expenditure and compensating fund in residents with various income in the experimental region. The low income residents had a high health service need and the government should improve NRCMS greatly to change the situation.
China ; Data Collection ; Delivery of Health Care ; Health Expenditures ; Health Services Needs and Demand ; Healthcare Disparities ; Humans ; Income ; Rural Health Services ; economics ; utilization
4.Socioeconomic distribution of health and health care utilization in a new town in Hong Kong, China.
Tak Sun Ignatius YU ; Tze Wai WONG
Biomedical and Environmental Sciences 2004;17(2):234-245
OBJECTIVESTo assess the association of socioeconomic indicators with various chronic and acute illnesses and the utilization of public health care in a new town in Hong Kong, China.
METHODSIllness experience and socioeconomic and demographic data of 7570 residents from 2022 randomly selected households were collected through telephone interviews. The relationships between socioeconomic indicators and illnesses/choice of health care were explored using stepwise logistic regressions after adjusting for sex and age.
RESULTSSignificant positive associations were noted between low household income and diabetes mellitus, any chronic illnesses among adults and flu among younger subjects; low educational level and accident-related illness among adults; being born in Chinese mainland and flu, any acute illness in adults. For the utilization of public health care, low household income was the most consistent risk factor.
CONCLUSIONThis study did not demonstrate a unidirectional socioeconomic gradient in health but supported the hypothesis that socioeconomic deprivation was associated with the utilization of public health care.
Acute Disease ; economics ; epidemiology ; Adolescent ; Adult ; Age Factors ; China ; Chronic Disease ; economics ; epidemiology ; Cities ; Cross-Sectional Studies ; Delivery of Health Care ; utilization ; Educational Status ; Employment ; Female ; Health Surveys ; Hong Kong ; epidemiology ; Housing ; Humans ; Income ; Male ; Prevalence ; Residence Characteristics ; Sex Factors ; Socioeconomic Factors