OBJECTIVES: The purpose of this study was to define the association between the medical utilization of osteoarthritis patient and its related factors. METHODS: We used the 2005 Korean National Health and Nutrition Survey data and we enrolled 2833 participants who were forty or older and who were diagnosed as having osteoarthritis by a doctor within 1 year and who had suffered from osteoarthritis for more than 3 months. The Andersen behavioral model was used as the analytic framework, and the variables were categorized into predisposing, enabling, and need factors. To determine the influence of each variable on the medical utilization of osteoarthritis patient, we applied hierarchical logistic regression analysis with two stages: the first stage included the predisposing and enabling factors and the second stage included the need factors. RESULTS: On the hierarchical logistic analysis, the variables of personal income, the type of medical security, the duration of arthritis related symptoms within 1 month, the subjective health status and the duration of osteoarthritis showed a statistically significant difference between whether the medical utilization in men patients. And the variables of age, limitation activity due to osteoarthritis, arthritis related symptoms within 1 month, and the subjective health status had a statistically significant difference between whether the medical utilization in women patients. CONCLUSIONS: The patients who tend to receive less care are those suffer less from symptoms of osteoarthritis, those who are within the initial phase, or those with a low-level severity of osteoarthritis. It is necessary to encourage patients to receive the treatment in the initial phase.
Adult ; Aged ; Female ; Health Services/*utilization ; Health Surveys ; Humans ; Male ; Middle Aged ; Osteoarthritis/*therapy ; Republic of Korea

PURPOSE: The purpose of this study was to measure home health resource utilization using a Case-Mix Adjustor Model developed in the U.S. METHOD: The subjects of this study were 484 patients who had received home health care more than 4 visits during a 60-day episode at 31 home health care institutions. Data on the 484 patients had to be merged onto a 60-day payment segment. Based on the results, the researcher classified home health resource groups (HHRG). RESULT: The subjects were classified into 34 HHRGs in Korea. Home health resource utilization according to clinical severity was in order of Minimum (C0) < 'Low (C1) < 'Moderate (C2) < 'High (C3), according to dependency in daily activities was in order of Minimum (F0) < 'High (F3) < 'Medium (F2) < 'Low (F1) < 'Maximum (F4). Resource utilization by HHRGs was the highest 564,735 won in group C0F0S2 (clinical severity minimum, dependency in daily activity minimum, service utilization moderate), and the lowest 97,000 won in group C2F3S1, so the former was 5.82 times higher than the latter. CONCLUSION: Resource utilization in home health care has become an issue of concern due to rising costs for home health care. The results suggest the need for more analytical attention on the utilization and expenditures for home care using a Case-Mix Adjustor Model.
Risk Adjustment ; Middle Aged ; Male ; Korea ; Humans ; Home Care Services/*utilization ; Health Resources/*utilization ; Female ; Aged, 80 and over ; Aged ; Adult

INTRODUCTIONThis study aims to examine the pattern of services utilisation and the factors associated with help-seeking behaviour among those with mental disorders in the multi-ethnic Asian population of Singapore.

MATERIALS AND METHODSA household survey was carried out on a nationally representative sample of the adult (18 years and above) resident population. The main instrument used to establish the diagnosis of mental disorders and the services sought was the Composite International Diagnostic Interview version 3.0 (CIDI 3.0). The 'services' component of the instrument contains questions, which examine service utilisation for mental health problems.

RESULTSA total number of 6616 completed respondents constituted a representative sample of the adult resident population in Singapore. Only 31.7% of those with mental disorders had sought help: 15.7% from mental health providers, 8.4% from general practitioners, and 7.6% from religious/ spiritual advisors or other healers. Among respondents with severe disability across any disorder assessed in our survey, 50.1% had sought help from some service in the past 12 months. Individuals with moderate or mild levels had lower rates of consultation, i.e. 35.4% and 30.6% respectively. The rate of using the Internet as a source of help was low in this population.

CONCLUSIONThere is a need to engage and work collaboratively with healthcare providers (including religious and spiritual healers) in the community to detect, assess and treat those with mental illness. More general practitioners need to be involved, and the role of the Internet also requires further consideration as a source for help.

Adult ; Female ; Health Care Surveys ; Health Services Needs and Demand ; Humans ; Internet ; utilization ; Male ; Mental Disorders ; therapy ; Mental Health Services ; utilization ; Middle Aged ; Patient Acceptance of Health Care ; statistics & numerical data ; Singapore ; Spiritual Therapies ; utilization

PURPOSE: The purpose of this study was to describe the current status of utilization and costs of home health nursing care by the levels of medical institutes in Korea. METHOD: A secondary analysis of existing data was used from the national electronic data information(EDI) of 148 home health agencies for 6 months from May to Oct 2005 in total. RESULT: The 148 agencies had multiple services in cerebral infaction, essential hypertension, sequela of cerebrovascular disease, type 2 diabetes mellitus, etc.. The highest 10 rankings of 76 categories of home health nursing services were composed of 96.4% of the total services, such as simple treatment, inflammatory treatment, urethra & bladder irrigation, inserting indwelling catheter etc., in that order. The highest 20 rankings of 226 categories of home examination services were composed of 77.0% of the total home examination services. In addition, the average cost of home health care per visit was 46,088 Won (approximately equal to 48 Dollars, 1 Dollar=960 Won). The costs ranged from 74,523 Won (approximately equal to 78 Dollars, loss of chronic kidney function, N18) to 32,270 Won (approximately equal to 34 Dollars, other cerebrovascular diseases, I67). CONCLUSION: Results suggest that client characteristics of hospital based HHNC are not different from community based HHNC or visiting nursing services for elderly. The national results will contribute to baseline data used to establish a policy for the home health nursing care system and education.
Adult ; Aged ; Aged, 80 and over ; Community Health Nursing ; Costs and Cost Analysis ; Fees and Charges ; Female ; Health Services for the Aged/*economics/utilization ; Home Care Agencies/*economics/utilization ; Home Care Services, Hospital-Based/*economics/utilization ; Home Nursing ; Humans ; Korea ; Male ; Middle Aged

OBJECTIVETo provide insight into the psychosocial factors underlying the utilisation of health services by women with reproductive tract infection (RTI) symptoms.

METHODSA cross-sectional study, adopting Aday and Andersen' s Social Behaviour Model, was conducted between 1998 and 1999 in Chinese Hebei province and Beijing. A total of 864 eligible married women (age 21 to 60 years) were face to face interviewed.

RESULTSThe percentage of self-reported symptoms of RTIs in urban and rural women was 35.6 and 46.8, respectively; the proportion of women with RTIs who utilised health services was 27.5% and 26.7%, respectively. Compared to urban women, rural women had less knowledge on RTIs and more traditional beliefs, and were more satisfied with local health services. The results of logistic regression analysis showed that the common factor influencing health service utilisation in women with RTIs was current experience of RTIs. Knowledge about self-medication, perceived social stigma attached to RTIs, prior experience of RTIs, family income and perceived severity of RTIs were also predictors of utilisation of health services in rural women with RTIs. Satisfaction with health providers, information received from health providers, prior experience of RTIs, occupation and medical care coverage were predictors of utilisation of health services in urban women with RTIs.

CONCLUSIONThe prevalence of RTIs is high, but the rate of seeking health services is low. There is a great need for emphasizing culturally acceptable reproductive health education in different places to improve women' s ability for self-care. Regular medical check-ups for women are also important. It is necessary to improve the quality of health service, complete the reform of health insurance and alleviate women' s social stigma related to RTIs, giving women social and moral support.

Adult ; China ; Cross-Sectional Studies ; Female ; Genital Diseases, Female ; therapy ; Health Services Needs and Demand ; Humans ; Infection ; therapy ; Middle Aged ; Rural Health ; Urban Health ; Women's Health Services ; utilization

PURPOSE: The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling. METHODS: Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis. RESULTS: Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization. CONCLUSION: The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/or promotion of community awareness.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case Management ; Child ; Female ; Health Services/*utilization ; Humans ; Male ; Medical Assistance/*utilization ; Middle Aged ; Models, Nursing ; Multilevel Analysis ; Republic of Korea ; Young Adult

OBJECTIVETo investigate the utilization of oral health services and to analyze the factors associated with oral health services for the community residents.

METHODSHousehold health interview and oral health condition survey were conducted to obtain information about oral health services. The respondents were recruited by a multi-stage random cluster sampling procedure. Multiple dummy regression analyses were performed for the assessment of the relative effect of behavioural factors on dental attendance.

RESULTSA total of 2003 families, 4459 people participated in this study. The people seeking dental treatment accounted for 11.3% (502/4459) per year. Young people (OR = 2.072), having medical insurance system (OR = 2.835), short distance to see dentist (OR = 3.535), oral health awareness (OR = 2.595), poor self-assessment of oral health status (OR = 2.014) were the main factors which influenced dental attendance of community residents.

CONCLUSIONSThe utilization of oral health service was low, particularly for middle-aged people and the elderly. Oral health education and medical insurance system should be strengthened.

Adolescent ; Adult ; Aged ; Dental Care ; economics ; utilization ; Dental Health Services ; economics ; utilization ; Health Services Accessibility ; statistics & numerical data ; Health Services Needs and Demand ; Humans ; Income ; statistics & numerical data ; Insurance, Dental ; statistics & numerical data ; Logistic Models ; Middle Aged ; Sampling Studies ; Self-Assessment ; Surveys and Questionnaires ; Urban Health Services ; utilization ; Urban Population ; Young Adult

BACKGROUND: The primary preventive services of TSeKaP promote disease prevention among marginalized groups. The threat of non-utilization, however, undermines the effective implementation of the program. To fill in the knowledge gap regarding utilization of primary preventive services, rate of utilization and factors associated with utilization of primary preventive services must be determined.

OBJECTIVE: To determine the rate of utilization and the association of selected factors with utilization of primary preventive services of TSeKaP among PhilHealth Indigent Member of Manila.

METHODS: Using a two-stage cluster sampling, 145 PhilHealth Indigent Members were randomly selected and interviewed. Chi-square test and Fisher's exact test were used to determine associations. FGDs were also conducted to gather reasons related to utilization.

RESULTS AND CONCLUSION: Among those surveyed, 68.28% were found to have utilized at least one primary preventive service. Age (p-value=0.021), knowledge (p-value=0.015), familiarity (p-value=0.029), and accessibility (p-value=0.013) were found to be associated with utilization. Utilization generally increases as the age group increases. Those with satisfactory knowledge on TSeKaP, those familiar with their health center, and those who report that their health center is accessible were 1.45 times, 2.12 times and 2.83 times more likely to utilize than their counterparts, respectively. Results showing a significant proportion of non-utilization emphasize the need to improve implementation strategies by improving not only the knowledge of respondents' on TSeKaP but also their familiarity with their health centers. The use of various communication channels, such as barangay bulletin, public address system, radio or television, may aid the dissemination of pertinent information regarding the program as perceived by the respondents.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Health Promotion ; Preventive Health Services ; Health Services, Indigenous ; Facilities And Services Utilization

Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly.
Aged ; Aged, 80 and over ; *Cultural Characteristics ; Evidence-Based Medicine ; Female ; Health Care Rationing/*statistics & numerical data ; Health Equity/*statistics & numerical data ; Health Services for the Aged/*utilization ; Humans ; Income/*statistics & numerical data ; India/epidemiology ; Male ; Middle Aged ; Socioeconomic Factors ; *Utilization Review

PURPOSE: This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. MATERIALS AND METHODS: The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. RESULTS: The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. CONCLUSION: This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program.
Adult ; Aged ; Body Mass Index ; *Case Management ; Diabetes Mellitus/*therapy ; Female ; *Health Behavior ; *Health Knowledge, Attitudes, Practice ; Health Services/*utilization ; Humans ; Male ; Middle Aged ; Republic of Korea ; *Self Care