BACKGROUND: This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2015 constructed according to the SHA2011, which is a new manual of System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analysing health accounts of OECD member countries. Particularly, financing public- private mix is parsed in depth using SHA data of both HF as financing schemes as well as FS (financing source) as their revenue types. METHODS: Data sources such as Health Insurance Review and Assessment Service's publications of both motor insurance and drugs are newly used to construct the 2015 National Health Accounts. In the case of private financing, an estimation of total expenditures for revenues by provider groups is made from the Economic Census data; and the household income and expenditure survey, Korean healthcare panel study, etc. are used to allocate those totals into functional classifications. RESULTS: CHE was 115.2 trillion won in 2015, which accounts for 7.4 percent of Korea's gross domestic product. It was a big increase of 9.3 trillion won, 8.8 percent, from the previous year. Government and compulsory schemes's share (or public share) of 56.4% of the CHE in 2015 was much lower than the OECD average of 72.6%. ‘Transfers from government domestic revenue’ share of total revenue of HF was 17.8% in Korea, lower than the other contribution-based countries. When it comes to ‘compulsory contributory health financing schemes,’‘Transfers from government domestic revenue’ share of 14.9% was again much lower compared to Japan (44.7%) and Belgium (34.8%) as contribution-based countries. CONCLUSION: Considering relatively lower public financing share in the inpatient care as well as overall low public financing share of total CHE, priorities in health insurance coverage need to be repositioned among inpatient care, outpatient care and drugs.
Ambulatory Care ; Belgium ; Censuses ; Classification ; Delivery of Health Care ; Family Characteristics ; Financing, Government ; Gross Domestic Product ; Health Expenditures* ; Healthcare Financing ; Humans ; Information Storage and Retrieval ; Inpatients ; Insurance ; Insurance, Health ; Japan ; Korea* ; Organisation for Economic Co-Operation and Development ; World Health Organization

BACKGROUND: This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2015 constructed according to the SHA2011, which is a new manual of System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analysing health accounts of OECD member countries. Particularly, financing public- private mix is parsed in depth using SHA data of both HF as financing schemes as well as FS (financing source) as their revenue types. METHODS: Data sources such as Health Insurance Review and Assessment Service's publications of both motor insurance and drugs are newly used to construct the 2015 National Health Accounts. In the case of private financing, an estimation of total expenditures for revenues by provider groups is made from the Economic Census data; and the household income and expenditure survey, Korean healthcare panel study, etc. are used to allocate those totals into functional classifications. RESULTS: CHE was 115.2 trillion won in 2015, which accounts for 7.4 percent of Korea's gross domestic product. It was a big increase of 9.3 trillion won, 8.8 percent, from the previous year. Government and compulsory schemes's share (or public share) of 56.4% of the CHE in 2015 was much lower than the OECD average of 72.6%. ‘Transfers from government domestic revenue’ share of total revenue of HF was 17.8% in Korea, lower than the other contribution-based countries. When it comes to ‘compulsory contributory health financing schemes,’‘Transfers from government domestic revenue’ share of 14.9% was again much lower compared to Japan (44.7%) and Belgium (34.8%) as contribution-based countries. CONCLUSION: Considering relatively lower public financing share in the inpatient care as well as overall low public financing share of total CHE, priorities in health insurance coverage need to be repositioned among inpatient care, outpatient care and drugs.
Ambulatory Care ; Belgium ; Censuses ; Classification ; Delivery of Health Care ; Family Characteristics ; Financing, Government ; Gross Domestic Product ; Health Expenditures* ; Healthcare Financing ; Humans ; Information Storage and Retrieval ; Inpatients ; Insurance ; Insurance, Health ; Japan ; Korea* ; Organisation for Economic Co-Operation and Development ; World Health Organization

A new manual of System of Health Accounts (SHA) 2011, was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. This offers more complete coverage than the previous version, SHA 1.0, within the functional classification in areas such as prevention and a precise approach for tracking financing in the health care sector using the new classification of financing schemes. This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 1970-2014 constructed according to the SHA2011. Data sources for public financing include budget and settlement documents of the government, various statistics from the National Health Insurance, and others. In the case of private financing, an estimation of total revenue by provider groups is made from the Economic Census data and the household income and expenditure survey, Korean healthcare panel study, etc. are used to allocate those totals into functional classifications. CHE was 105 trillion won in 2014, which accounts for 7.1% of Korea's gross domestic product. It was a big increase of 7.7 trillion won, 7.9%, from the previous year. Public share (government and compulsory schemes) accounting for 56.5% of the CHE in 2014 was still much lower than the OECD average of about 73%. With these estimates, it is possible to compare health expenditures of Korea and other countries better. Awareness and appreciation of the need and gains from applying SHA2011 for the health expenditure classification are expected to increase as OECD health expenditure figures get more frequently quoted among health policy makers.
Budgets ; Censuses ; Classification ; Delivery of Health Care ; Family Characteristics ; Financing, Government ; Gross Domestic Product ; Health Care Sector ; Health Expenditures* ; Health Policy ; Information Storage and Retrieval ; Korea* ; National Health Programs ; Organisation for Economic Co-Operation and Development ; World Health Organization

OBJECTIVE: Acute appendicitis is one of the most urgent surgical problems. Several factors have been considered as predictors of perforation, but this study focused on the change in pain pattern. The degree of pain and progression of appendicitis were analyzed assuming that the pain intensity would increase until the perforation and the degree of pain would decrease immediately after the perforation occurred. METHODS: In this study, 385 out of 467 patients, who were diagnosed with appendicitis in a single institution and aged between 15 and 65 years, were reviewed retrospectively. The patients' pain scores and the diameters of appendices were analyzed along with the accompanying complications. Correlation analysis and a Student's t-test were performed. RESULTS: In patients with complicated appendicitis, the mean numerical rating scale (NRS) was slightly higher than that of simple appendicitis, but there was no significant difference in the absolute value. Only the size of the appendix showed meaningful differences according to the combined computed tomography findings. The NRS distribution or appendiceal size did not correlate with the time duration from symptom onset. CONCLUSION: The appendiceal size tended to increase with progressing appendicitis. No significant correlation was observed between the patient's pain level and complications. The time duration from symptom onset did not show a relationship with the progression of appendicitis.
Abdominal Pain ; Appendicitis* ; Appendix ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Pain Measurement ; Retrospective Studies

Background: Readmissions related to lack of quality care harm both patients and health insurance finances. If the factors affecting readmission are identified, the readmission can be managed by controlling those factors. This paper aims to identify factors that affect readmissions of convalescent rehabilitation patients. Methods: Health Insurance Review and Assessment Service claims data were used to identify readmissions of convalescent patients who were admitted in hospitals and long-term care hospitals nationwide in 2018. Based on prior research, the socio-demographics, clinical, medical institution, and staffing levels characteristics were included in the research model as independent variables. Readmissions for convalescent rehabilitation treatment within 30 days after discharge were analyzed using logistic regression and generalization estimation equation. Results: The average readmission rate of the study subjects was 24.4%, and the risk of readmission decreases as age, length of stay, and the number of patients per physical therapist increase. In the patient group, the risk of readmission is lower in the spinal cord injury group and the musculoskeletal system group than in the brain injury group. The risk of readmission increases as the severity of patients and the number of patients per rehabilitation medicine specialist increases. Besides, the readmission risk is higher in men than women and long-term care hospitals than hospitals. Conclusion “Reducing the readmission rate” is consistent with the ultimate goal of the convalescent rehabilitation system. Thus, it is necessary to prepare a mechanism for policy management of readmission.

Traditionally, radical hysterectomy is the main surgical method for the treatment of early cervical carcinoma and always results in the loss of fertility. But, large numbers of young women are recently being diagnosed with cervical carcinoma and fertility preservation has become a concern. So, there has been a move towards more conservative approaches for the treatment of cervical carcinoma in recent years. Radical trachelectomy, which allows preservation of uterus but removes the cervix, parametrium and upper one third of the vagina, is a conservative but locally radical procedure. We performed radical abdominal trachelectomy with pelvic lymphadenectomy for two cases of invasive cervical carcinomas, which may be the first report in korea. One patient was 37 years old single women who had stage Ib cervical cancer and was disease free for 17 months after treatment. The other patient was 19 years old student who was also single and had stage IIa cervical cancer and was disease free for 14 months after treatment. We report the first two cases and review the literature on radical trachelectomy.
Adult ; Cervix Uteri ; Female ; Fertility ; Fertility Preservation ; Humans ; Hysterectomy ; Korea ; Lymph Node Excision* ; Uterine Cervical Neoplasms ; Uterus ; Vagina ; Young Adult

BACKGROUND: Hereditary spherocytosis(HS) is a clinically and biochemically very heterogeneous disorder The purpose of this study is to detect erythrocyte membrane protein abnormalities by SDS-PAGE and to investigate the frequency of erythrocyte membrane protein defects in hereditary spherocytosis and correlation between some of the hereditary spherocytosis biochemical subsets and the selected clinical phenotype. METHODS: We evaluated the clinical and laboratory characteristics of 14 normal healthy persons and 23 hereditary spherocytosis patients and 8 their family members. The patients were divided into three groups based on clinical and hematological severity(mild, typical, severe). In addition to routine hematologic determlnatlons, osmotic fragility and autohemolysis, RBC membrane protein analysis were performed in all patients by densitometric tracing of SDS-PAGE(sodium dodecyl sulphate polyacrylamide gel electrophoresis) stained by Coomassle blue utilizing both the discontinuous buffer system of Laemmli with acrylamide linear gradient from 4% to 12% and the continuous buffer system of Fairbank with exponential gradient of acrylamide from 3.5% to 17%. RESULTS: 1) The patients could be seperated into three classes of different clinical severity as mild(3 cases), moderate(16 cases) and severe(4 cases) on the clinical feature. 2) Eighteen patients(82.6%) among 23 hereditary spherocytosis revealed abnormal erythrocyte membrane protein and we detected six patients(26.1%) with spectrin deficiency combined with ankyrin reduction, 4 patients(17.4%) with ankyrin deficiency, 4 patients(17.4%) with isolated spectrin deficiency and 3 patients(13.0%) with band 3 deficiency. Five HS patients(21.7%) showed normal RBC membrane protein. 3) Eight HS and their family members showed same RBC membrane protein deficiency. 4) The type and degree of RBC membrane protein reduction were variale with spectrin at 66~94%, with ankyrin at 48~82% of normal levels. These showed that each patient had different clinical severities according to different RBC membrane protein levels and type. CONCLUSION: RBC membrane protein abnormalities were observed in 82.6% of HS patients. The combined spectrin and ankyrin deficiency is the most common molecular defect in HS. The clinical severity and biochemical expression is heterogeneous. SDS-PAGE analysis of RBC membrane protein was provided the diagnosis of RBC membrane defects and basic molecular studies. We believed that the early identification of the biochemical defect responsible for HS is important because it is helpful starling point for the identification of the primary molecular defect, and it could help to anticipate the clinical outcome of the disease. For these reasons, we consider the SDS-PAGE of the red cell membrane to be of crucial importance for a complete evaluation of children with HS. Further studies with more cases would be to clarify the correlation between clinical and biochemical phenotypes.
Acrylamide ; Ankyrins ; Cell Membrane ; Child ; Diagnosis ; Electrophoresis, Polyacrylamide Gel* ; Erythrocyte Membrane* ; Erythrocytes* ; Erythrocytes, Abnormal ; Humans ; Membrane Proteins ; Membranes ; Osmotic Fragility ; Phenotype ; Population Characteristics* ; Spectrin ; Starlings

We studied the intradural variations of spinal nerve rootlets in 100 cases of Korean adults. The results of the study are as follows ; 1. The incidence of intrasegmental variations (abberrant rootlets) is high in cervical segments and decreased toward lumbosacral segments. The incidence is higher in posterior rootlets than anterior, except cervical sesments. 2. The incidence of intersegmental variations is higher in posterior rootlets than anterior, and generally high in cervical and lumbar segments. 3. We divide the intersegmental variations into supernumerary rootlets, dividing rootlets, and anastomosing rootlets, and among them the incidence of anastomosing rootlets is higher. We divide the anastomosing rootlets into parallel anastomosing rootlets, uniting anastomosing rootlets, and rearrangement anastomosing rootlets. 4. The anterior to posterior anastomosing of spinal nerve rootlet is present in 4 of cases studied.
Adult ; Humans ; Incidence ; Spinal Nerves*

This paper introduces statistics related to the size and composition of Korea's total health expenditure. The figures produced were tailored to the OECD's system of health accounts. Korea's total health expenditure in 2009 was estimated at 73.7 trillion won (US$ 57.7 billion). The annual per capita health expenditure was equivalent to US$ PPP 1,879. Korea's total health expenditure as a share of gross domestic product was 6.9% in 2009, far below the OECD average of 9.5%. Korea's public financing share of total health expenditure increased rapidly from less than 50% before 2000 to 58.2% in 2009. However, despite this growth, Korea's share remained the fourth lowest among OECD countries that had an average public share of 71.5%. Inpatient, outpatient, and pharmaceutical care accounted for 32.1%, 33.0%, and 23.7% of current health expenditure in 2009, respectively. A total of 41.1% of current health expenditure went to hospitals, 28.1% to providers of ambulatory healthcare (15.9% on doctor's clinics), and 17.9% to pharmacies. More investment in the translation of national health account data into policy-relevant information is suggested for future progress.
Delivery of Health Care/economics/*trends ; Health Expenditures/statistics & numerical data/*trends ; Humans ; Republic of Korea

This study attempted to identify factors work environment that affect job satisfaction in dental hygienists. This study was conducted between August 29 and September 28, 2017, as part of an in-depth study of the ‘Survey on the Working Environment of Clinical Dental Hygienists’ of the Korean Dental Hygienists Association. To get the responses, the questionnaire was posted on the website of the Korean Dental Hygienists Association, and of the respondents, 4,663 were selected and analyzed. An independent t-test and one way ANOVA analysis were used to make a comparison of job satisfaction according to the general characteristics, salary, and tasks. Logistic regression analysis was conducted to identify factors affecting job satisfaction. The significance level was 0.05. In regard to salary information, the job satisfaction was found to be high (p < 0.001) in cases where the salary was considered appropriate, when incentives were provided, when rewards or vacation expenses were supported, and when overtime and nightly work allowances were paid. In regard to job information, the job satisfaction was found to be high (p < 0.001) when the volume of work was considered appropriate, when there were sufficient numbers in the workforce, and when the division of labor among the other personnel was clear. As a factor affecting job satisfaction of dental hygienists, the case of thinking that ‘workload is appropriate’ was found to be 2.052 times, showing the highest score. Job satisfaction in dental hygienists affects the turnover and has a significant effect on the performance of the organization. Therefore, it is believed, that it is urgent to improve the working environment such as salary and clear division of duties affecting job satisfaction of dental hygienists.
Dental Hygienists* ; Humans ; Job Satisfaction* ; Logistic Models ; Motivation ; Reward ; Salaries and Fringe Benefits ; Surveys and Questionnaires ; Thinking