OBJECTIVES: This study was performed to compare the standardized mortality ratios among different small areas and to explore the usefulness of standardized mortality ratios in South Korea. METHODS: To calculate the standardized mortality ratio (SMR), we obtained the national deaths certificate data (2004-2006) and national registration population data (2003-2006), and these were provided by the National Statistical Office. The small areas (Eup.Myoun.Dong) were based on the subdivisions of counties. Among the 3,580 small areas classified by the National Statistical Office, 3,571 areas were included in this study. The basic statistics and decile distributions of the SMRs for all the regional levels were calculated, and the small area maps were also produced for some selected regions. To evaluate the precision of SMR, we calculated the 95% confidence intervals of the SMR in selected small areas. RESULTS: The mean and the standard deviation of the SMRs among all small areas were 100.8 and 17.0, respectively. The range was 30.6-211.7 and the inter-quartile range was 20.7. Seoul metropolitan city displayed the lowest mean SMR among 16 regions in South Korea, and 34.6 percent of the small area SMRs belonged to the first decile(the lowest group). On the contrary, the mean SMR of Gyeongsangnam province was highest, and 26.1 percent of the small area SMRs belonged to the tenth decile(the highest group). In some areas, the precision of the SMR, which was calculated by the 95% confidence intervals, remained questionable, yet it was quite stable for almost areas. CONCLUSIONS: The standardized mortality ratios can be useful for allocating health resources at the small area level in Korea.
Death Certificates ; *Healthcare Disparities ; Humans ; Korea/epidemiology ; Mortality/*trends ; Public Health ; *Small-Area Analysis

Lively discussion has been underway regarding primary care in South Korea as an alternative medical policy in the face of rising medical costs and health care disparities. However, the lack of research about primary care in South Korea makes it difficult to move policymakers, so it is time to enhance primary care research in South Korea. Primary care research can be defined as research directed toward the better understanding and practice of the primary care function. Primary care research traditionally has included basic research, clinical research, health services research related to primary care, health systems research, and research on primary care training; and each field is complementary. In primary care research, participation of primary care physicians is essential because primary care research is different from other conventional studies of disease prevalence, patient characteristics, diagnostic methods, and the treatment environment. Primary care research findings in other countries cannot be applied to South Korea as the characteristics of the health system and medical practice are different. To enhance the research on primary care in South Korea, financial assistance, promoting the research capacity of primary care physicians, and more attention from primary care physicians to research are needed.
Health Services Research ; Healthcare Disparities ; Humans ; Physicians, Primary Care ; Prevalence ; Primary Health Care ; Republic of Korea

OBJECTIVE: To investigate the accessibility of medical services for Korean people with spinal cord injury (SCI) compared to the control group (CG) and to evaluate significantly related factors. METHODS: A total of 363 community dwelling people with chronic SCI were enrolled and 1,089 age- and sex-matched subjects were randomly selected from the general population as the CG. Self-reported access to medical services was measured by asking "Have you experienced the need for a hospital visit in the last year but could not?". This was followed up by asking the reasons for not receiving services when medically necessary. Variables, including lack of finances, difficulties making medical appointments, and lack of transportation were evaluated for accessibility to medical services. RESULTS: Sixty subjects (16.5%) in the SCI group had difficulties receiving medical services due to a lack of accessibility, compared to 45 (4.1%) in the CG (p<0.001). Variables causing difficulties receiving medical services were lack of transportation (27 persons, 45%), lack of finances (24 persons, 40%), and difficulty scheduling hospital appointments (9 persons, 15%) in the SCI group. In the CG, availability (lack of available time) and acceptability (deciding not to visit the hospital due to mild symptoms) were the reasons for not receiving medical care. CONCLUSION: People with SCI experienced limited accessibility to medical services, which was due to environmental rather than personal factors compared to that in the CG. Therefore, development of social policies to reduce or remove environmental variables is necessary.
Appointments and Schedules ; Health Services Accessibility ; Healthcare Disparities ; Humans ; Public Policy ; Spinal Cord Injuries* ; Transportation

OBJECTIVE: To investigate the accessibility of medical services for Korean people with spinal cord injury (SCI) compared to the control group (CG) and to evaluate significantly related factors. METHODS: A total of 363 community dwelling people with chronic SCI were enrolled and 1,089 age- and sex-matched subjects were randomly selected from the general population as the CG. Self-reported access to medical services was measured by asking "Have you experienced the need for a hospital visit in the last year but could not?". This was followed up by asking the reasons for not receiving services when medically necessary. Variables, including lack of finances, difficulties making medical appointments, and lack of transportation were evaluated for accessibility to medical services. RESULTS: Sixty subjects (16.5%) in the SCI group had difficulties receiving medical services due to a lack of accessibility, compared to 45 (4.1%) in the CG (p<0.001). Variables causing difficulties receiving medical services were lack of transportation (27 persons, 45%), lack of finances (24 persons, 40%), and difficulty scheduling hospital appointments (9 persons, 15%) in the SCI group. In the CG, availability (lack of available time) and acceptability (deciding not to visit the hospital due to mild symptoms) were the reasons for not receiving medical care. CONCLUSION: People with SCI experienced limited accessibility to medical services, which was due to environmental rather than personal factors compared to that in the CG. Therefore, development of social policies to reduce or remove environmental variables is necessary.
Appointments and Schedules ; Health Services Accessibility ; Healthcare Disparities ; Humans ; Public Policy ; Spinal Cord Injuries* ; Transportation

This paper proposes a media access control (MAC) layer design for wireless body area network (WBAN) systems. WBAN is a technology that targets for wireless networking of wearable and implantable body sensors which monitor vital body signs, such as heart-rate, body temperature, blood pressure, etc. It has been receiving attentions from international organizations, e. g. the Institute of Electrical and Electronics Engineers (IEEE), due to its capability of providing efficient healthcare services and clinical management. This paper reviews the standardization procedure of WBAN and summarizes the challenge of the MAC layer design. It also discusses the methods of improving power consumption performance, which is one of the major issues of WBAN systems.
Equipment Design ; Health Services Accessibility ; trends ; Healthcare Disparities ; Humans ; Monitoring, Physiologic ; instrumentation ; Telemedicine ; instrumentation ; Wireless Technology

BACKGROUNDGetting medical treatment is still difficult and expensive in western China. Improving the equity of basic health services is one of the tasks of the new healthcare reform in China. This study aimed to analyze the parallel and vertical equity of health service utilization of urban residents and then find its influencing factors.

METHODSIn August 2011, a household survey was conducted at 18 communities of Baoji City by multi-stage stratified random sampling. Based on the survey data, we calculated a concentration index of health service utilization for different income residents and a difference index of different ages. We then investigated the influencing factors of health service utilization by employing the Logistic regression model and log-linear regression model.

RESULTSThe two-week morbidity rate of sampled residents was 19.43%, the morbidity rate of chronic diseases was 21.68%, and the required hospitalization rate after medical diagnosis was 11.36%. Among out-patient service utilization, the two-week out-patient rate, number of two-week out-patients, and out-patient expense had good parallel and vertical equity, while out-patient compensation expense had poor parallel and vertical equity. The inpatient service utilization, hospitalization rate, number of inpatients, days stayed in the hospital, and inpatient expense had good parallel equity, while inpatient compensation expense had poor parallel equity. While the hospitalization rate and number of inpatients had vertical equity, the days stayed in hospital, inpatient expense, and inpatient compensation expense had vertical inequity.

CONCLUSIONSUrban residents' health was at a low level and there was not good health service utilization. There existed rather poor equity of out-patient compensation expense. The equity of inpatient service utilization was quite poor. Income difference and the type of medical insurance had great effects on the equity of health service utilization.

China ; Health Services ; utilization ; Healthcare Disparities ; Humans ; Multivariate Analysis ; Urban Health Services

OBJECTIVES: To identify the importance of preventing tuberculosis for HIV (Human Immunodeficiency Virus) infectees and to monitor their management of health, we investigated the proportion of HIV-TB (Tuberculosis) deaths among the HIV deaths and its related factors. METHODS: Data for HIV deaths from 2002 to 2010 was acquired from Statistics Korea, after which the HIV deaths were reclassified into HIV-TB deaths or other deaths according to the KCD (Korean Classification of Diseases). We analyzed the proportion of HIV-TB deaths among HIV disease deaths and the relationship between HIV-TB deaths and related variables such as sex, age, educational level, marital status, etc. RESULTS: There were 774 HIV deaths in South Korea between 2002 and 2010. TB was the main cause of death in 10.1% of all HIV deaths. The total proportion of HIV-TB deaths was 10.1% but its proportion reached 16.3% between 2005-2007 and then decreased to 4% in 2010. Also, the proportion of HIV-TB deaths was significantly high in the young age groups, but its proportion was significantly low in married groups and well educated groups (p<0.05). CONCLUSIONS: The result implies that the policy that takes care of HIV infectee regarding TB prevention has been getting systemized on a national scale. Also, HIV-TB deaths have been affected by social factors such as education and marriage status.
Cause of Death ; Classification ; Education ; Healthcare Disparities ; HIV* ; Humans ; Korea ; Marital Status ; Marriage ; Tuberculosis*

The role of physicians in reducing health inequity has been regarded only partial and anecdotal by most policymakers. Clinicians, primary care physicians in particular, do not have sufficient opportunities to be engaged in activities dealing with health equity. However, physicians are playing a key role in providing health care and health-related programs, usually interwoven with inequities in health and health care utilization. As a result, a more active role for physicians must be identified under the scheme of a comprehensive strategy in combating inequity in health. From the perspective of mediating factors linking social determinants of health and inequitable outcomes in health and health care, health behaviors, access, and processes of care are identified as potential areas for physicians' engagement. 'Health equity capacity' is emphasized as a cross-cutting tool to empower physicians to address inequity in their clinical practices. More broadly, practicing physicians are able to support their colleagues and communities through diverse activities and participation: technical assistance, research and education, community involvement, and advocacy. Among them, raising awareness and changing perceptions are indicated as crucial factors facilitating physicians' contribution to minimizing inequity.
Clinical Competence ; Delivery of Health Care ; Health Behavior ; Health Status Disparities ; Healthcare Disparities ; Humans ; Negotiating ; Physicians, Primary Care ; Professional Role ; Socioeconomic Factors

BACKGROUND: Health examinations are performed so that diseases can be identified and treated earlier. Several studies have evaluated the determinants of participation in health examinations including cancer screening, but few have evaluated the relationship between the size of the enterprise and their participation in Workers' General Health Examinations (WGHE). The aim of the present study was to estimate the association of WGHE participation with the size of the enterprise and the type of policyholder. METHODS: The eligible population from 2006 through 2013 was extracted from the National Health Insurance Service (NHIS) database. The population size ranged from 14–17 million. After adjustment for age and gender, multiple logistic regression analysis was performed to estimate the odds ratios of participating in the WGHE (by age group) based on the type of policyholder (reference: public officers) and the size of the enterprise (reference: enterprise size ≥300 employees), respectively. RESULTS: Workers employed at enterprises with <50 persons were less likely to participate in WGHEs than those employed at enterprises with ≥300 persons. After policyholders were stratified by type (non-office workers vs. public officers), a disparity in the WGHE participation rate was found between the different types of policyholders at enterprises with <50 employees (reference: those employed at enterprises with ≥300 employees); the odds ratios for subjects in their 40s and 50s were 0.2–0.3 for non-office workers vs. 0.8–2.0 for public officers. CONCLUSION: Workplace policyholders at small enterprises comprised a vulnerable group less likely to participate in WGHEs. Efforts should be made to raise the WGHE participation rate among the vulnerable employees belonging to small enterprises, as well as among their dependents.
Early Detection of Cancer ; Healthcare Disparities ; Humans ; Logistic Models ; Mass Screening ; National Health Programs ; Odds Ratio ; Population Density ; Socioeconomic Factors*

OBJECTIVETo assess the extent and relative changes of the equities in prenatal care utilization among women with different educational attainment in some areas of China.

METHODSData were collected in 13 counties/cities covered by Perinatal Health Care Surveillance System established by Institute of Reproductive and Child Health, Peking University. The study population consisted of 103 704 women who delivered single live births in 1994 and 2000. Chi-square and multiple logistic regression were employed to compare the systematic management rates and relative risks. Concentration index was used to assess the relative changes of equities in prenatal care utilization. SPSS 11.5 and Microsoft Excel 2003 were used for analysis.

RESULTSThe total systematic management rate was 22.1% in 1994 and 57.4% in 2000. The concentration index was -0.046 in 1994 and 0.066 in 2000. In northern areas, the concentration index increased from 0.015 in 1994 to 0.295 in 2000, while it increased from -0.015 in 1994 to 0.062 in 2000 in southern areas. In rural areas, the concentration index increased from 0.002 in 1994 to 0.026 in 2000, while it decreased from 0.042 in 1994 to 0.019 in 2000 in urban areas.

CONCLUSIONInequities in prenatal care utilization in 2000 become more obvious than in 1994, especially in northern areas. More attention should be paid to solve the inequities.

China ; Culture ; Female ; Health Care Rationing ; Healthcare Disparities ; Humans ; Prenatal Care ; statistics & numerical data ; utilization ; Rural Population