BACKGROUND: Medical Aid (MA) beneficiaries, belonging to low-income and vulnerable groups, tend to utilize more healthcare services than patients covered by general health insurance. This study aimed to investigate shifts in medical expenses among South Korean MA beneficiaries from 2010 to 2020 in response to changes in health coverage. METHODS: This study was a retrospective cohort study that involved analyzing data from 354,289 MA beneficiaries aged 20 years and older as of 2010 whose healthcare utilization data could be tracked up to 2020. The impact of changes in health coverage of MA beneficiaries on the increase in medical expenses was analyzed with multiple logistic regression analysis. RESULTS: The findings revealed that the group maintaining their MA eligibility had a higher rate of increase in medical expenses compared to those transitioning from MA to National Health Insurance (NHI). Even after adjusting for covariates, the likelihood of an increase in total annual medical expenses was more than 1.4 times higher for the MA maintenance group. However, the group that maintained MA also had higher initial healthcare expenses, indicating poorer health status, compared to the group that transitioned to NHI. CONCLUSION In the public healthcare domain, such as MA, it is crucial to enhance access to necessary healthcare services while preventing unnecessary medical treatments. There is a need for systemic improvements to ensure that low-income, medically vulnerable groups can appropriately use the healthcare services they require to achieve high-value health outcomes.
Republic of Korea ; Humans ; Retrospective Studies ; Middle Aged ; Adult ; Female ; Poverty/statistics & numerical data* ; Male ; Vulnerable Populations/statistics & numerical data* ; Aged ; Health Expenditures/statistics & numerical data* ; Young Adult ; Medical Assistance/statistics & numerical data* ; Insurance Coverage/statistics & numerical data*

Medical assistance programs are government-funded programs that provide financial assistance to low-income individuals and families. These programs aim to reduce financial burdens and improve health care access. Coverage may include outpatient visits, hospital care, mental health services, diagnostic work-ups, prescriptions, and other services. This increases the detection of health conditions and improves drug utilization.1 2 3 Even though government health schemes and compulsory contributory health care financing schemes (e.g., PhilHealth) accounted for the majority of health expenditures in the Philippines, household out-of-pocket (OOP) payment still remains high. In 2022, the country’s total health expenditure (THE) was Php 1.12 trillion, with government health schemes and compulsory contributory health care financing schemes accounting for 44.8% of the THE and household OOP payment accounting for 44.7%. Thus, every Filipino spent an average amount of Php 10,059.49 for health care goods and services in 2022
Medical Assistance ; Health Services Accessibility ; Mental Health Services

BACKGROUND: In 2016, the Philippine Health Insurance Corporation (PhilHealth) introduced the Z-package to provide financial coverage for, among others, intramedullary nailing procedures and implant costs for eligible patients with femoral shaft fractures. OBJECTIVE: To compare health care durations and expenses between patients with closed femoral shaft fractures requiring intramedullary fixation who utilized the PhilHealth Z-package and those who did not. DESIGN: Retrospective cohort study. PARTICIPANTS: 66 male and female patients, aged 19 to 39 years, who underwent intramedullary nailing for closed femoral shaft fractures. SETTING: Orthopedic Ward, Southern Philippines Medical Center, Davao City, January to December 2018. MAIN OUTCOME PROCEDURE: Time to surgery, length of hospital stay, total hospital bill, total PhilHealth coverage, other funds for medical assistance (OFMA) coverage, and out-of-pocket (OOP) expenses. MAIN RESULTS: Among the 66 patients, 33 had the Z-package, while the remaining 33 did not. The median time to surgery (19 days vs 24 days; p=0.156), median length of hospital stay (24 days vs 29 days; p=0.546), and median total hospital bill (Php 62,392.00 vs Php 62,404.80; p=0.314) were comparable between those without the Z-package and those who had, respectively. However, patients without the Z-package had significantly lower total PhilHealth coverage (Php 30,740.00 vs Php 48,740.00; p<0.001) and higher OFMA coverage (Php 49,909.90 vs Php 34,409.20; p=0.024), and OOP expenses (Php 0.00; IQR: Php 0.00 to Php 20,000.00 vs Php 0.00; IQR: Php 0.00 to Php 0.00; p=0.004) compared to those with the Z-package. CONCLUSION Patients with the Z-package had a slightly longer time to surgery, although this difference was not statistically significant. However, they benefited from significantly lower remaining bills after PhilHealth coverage and reduced OOP expenses compared to patients without Z-package coverage.
PhilHealth coverage ; out-of-pocket expenses ; medical assistance ; length of stay

Objective:b> To understand the social security situation of current cases of pneumoconiosis in non-coal mine industries in Jiangsu Province, and to provide reference for the treatment and security work of pneumoconiosis patients. Methods:b> From January to October 2020, a follow-up survey was conducted on 4038 cases of pneumoconiosis in non-coal mine industries of the province from October 1949 to December 2019. The age, type of pneumoconiosis, industry type, and social security status of the patients were collected. Namely, work-related injury insurance, employer compensation, basic medical insurance for urban and rural residents, major illness insurance, etc. SPSS 19.0 was used for statistical description and analysis. Results:b> The cases of pneumoconiosis in non-coal mine industries in Jiangsu Province ranged in age from 36 to 105 (70.78±8.43) years old, and had been exposed to dust for 1 to 55 (19.27±9.29) years. Silicosis was the main form (3875 cases, 95.96%), and non-metallic mining and dressing industry was the main form (2618 cases, 64.83%). A total of 3991 cases (98.84%) of pneumoconiosis patients enjoyed social security, most of them were urban and rural residents with basic medical insurance (3624 cases, 89.75%), but there were still 47 patients without any social security. 15 cases (0.37%) enjoyed the subsistence allowance, with the monthly allowance amount ranging from 104 to 3960 yuan, with the average amount of 954.87 yuan/month. Conclusion:b> In Jiangsu Province, the proportion of pneumoconiosis patients in non-coal mine industries enjoying social security is relatively high, but there are still patients who do not enjoy any social security, and the difference in the amount of subsistence allowance is slightly larger. It is necessary to further improve the medical security of pneumoconiosis patients and improve their quality of life.
Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Social Security ; Prevalence ; Quality of Life ; Pneumoconiosis/epidemiology* ; Silicosis/epidemiology* ; Etoposide ; Ifosfamide ; Mesna ; Coal Mining ; China/epidemiology*

Background: The Universal Health Care (UHC) Act is a landmark legislation that seeks to improve provision of comprehensive health services through the integration of local health systems. The Department of Health (DOH) conducted a series of roundtable discussions to gather stakeholders' inputs and concerns to refine the initial draft of the Implementing Rules and Regulations (IRR) of UHC. Methods: On April 4, 2019, the Department of Health led a roundtable discussion on the Local Health Systems sections of the UHC IRR in collaboration with University of the Philippines Manila. A total of 65 stakeholders from different sectors participated in a semi-structured roundtable event. The proceedings were audio recorded and transcribed. A thematic analysis was done using NVivo 12 software to document gaps and gray areas identified by the participants. Results: Concerns of the participants revolved around the following: role of the private sector in local health systems; the integration of different municipal and other component health systems into a province-wide health system; organizational design of the health systems; pooling and utilization of the Special Health Fund (SHF). Gaps andgray areas were concentrated on the transfer of personnel and other health resources to the province-wide system, the composition of the Provincial Health Board, and the utilization and management of the SHF. Conclusion The roundtable event acquired various perspectives from stakeholders that could help the DOH identify priority action points that could be resolved at the agency level. The identified themes from the study analysis could be of value to decision makers to clarify issues, address policy gaps, and to prioritize future research directions.
Universal Health Care ; Policy Making ; Medical Assistance ; Government Programs ; Health Policy ;

BACKGROUND/AIMS: Public hospitals were established to provide high quality medical services to low socioeconomic status patients. This study examined the effects of public hospitals on the treatment and prognosis of patients with five-major gastrointestinal (GI) cancers (stomach cancer, colon cancer, liver cancer, bile duct cancer, and pancreatic cancer).METHODS: Among the 1,268 patients treated at Seoul National University Boramae Medical Center from January 2010 to December 2017, 164 (13%) were in the medicare group. The data were analyzed to identify and compare the clinical manifestations, treatment modality, and clinical outcomes between the groups.RESULTS: No statistically significant differences in the clinical data (age, sex), treatment method, and five-year survival rate were observed between the health insurance group and medicare group in the five major GI cancer patients. On the other hand, some medicare group patients tended more comorbidities and fewer treatment options than health insurance patients.CONCLUSIONS: Public hospitals have a positive effect on the treatment and prognosis in medicare group patients with the five-major GI cancers.
Bile Duct Neoplasms ; Colonic Neoplasms ; Comorbidity ; Gastrointestinal Neoplasms ; Hand ; Hospitals, Public ; Humans ; Insurance Coverage ; Insurance, Health ; Liver Neoplasms ; Medicare ; Methods ; Prognosis ; Retrospective Studies ; Seoul ; Social Class ; Survival Rate

Objective: The objectives of this paper were to describe and analyze the utilization of the Department of Health-Medical Assistance Program (DOH-MAP) at the University of the Philippines-Philippine General Hospital (UP-PGH) in order to provide actual data on its implementation and to give recommendations on future enforcement. Methods: Clinical and fiscal records of DOH-MAP recipients were prospectively tracked and analyzed from January to June 2018. Results: A total of Php 20,875,291.98 was utilized in the program from January to June 2018. The departments of Medicine (29.68%), Surgery (26.25%), and Neurosciences (15.99%) were identified as the clinical departments with the highest allocation of assistance fund. The pharmacy (64.28%), laboratory (12.87%), and outsourced medical equipment and services from EQUILIFE (10.26%) were determined to be the cost centers with the highest allotment. Conclusion The clinical departments and cost centers with high funding utilization identified in this study are recommended to be given appropriate increase in budget allocation, equipment procurement, maintenance and enhancement, and service improvement in order to provide a comprehensive health service delivery for patients of UP-PGH.
Health Expenditures ; Healthcare Financing ; Medical Assistance

PURPOSE: This qualitative study aimed to develop a substantive theory of the process of adaptation to motherhood in Central Asian-Korean immigrants to Korea.METHODS: Individual, in-depth interviews were conducted from July to September 2017, with 18 women who emigrated of Korean ethnicity from Central Asia to Korea, and took care of their baby for at least a year after their first delivery in Korea. The interviews were audio-recorded and transcribed verbatim. Data from the transcriptions were analyzed through Strauss and Corbin's grounded theory method, and data analysis was conducted simultaneously with data collection.RESULTS: As a result of categorizing the interview data through the process of open coding, 10 categories, with 31 subcategories and 102 concepts were drawn, and “growth as a Central Asian-Korean mother in an unfamiliar, historical hometown” was found to be the core category of the process of adaptation to motherhood in Central Asian-Korean immigrants to Korea.CONCLUSION: A characteristic of the process of adaptation to motherhood in Central Asian-Korean immigrants to Korea, drawn from this study, is that it differs according to the level of initiative to carry out interaction strategies, and the use of various supportive social resources. The findings indicate the need for Medicare eligibility adjustment for antenatal care, the extension of the visa renewal period during childbirth, the development of web- or mobile application-based educational programs in Russian language, and the establishment of integrated visiting healthcare services, community service resources, and policy support to enable these women to utilize various supportive social resources.
Adaptation, Psychological ; Asia ; Clinical Coding ; Data Collection ; Delivery of Health Care ; Emigrants and Immigrants ; Female ; Grounded Theory ; Humans ; Korea ; Medicare ; Methods ; Mothers ; Parturition ; Qualitative Research ; Social Welfare ; Statistics as Topic

PURPOSE: This study aimed to determine health problems experienced by workers in special employment relationships (WSER) and identify coping strategies used when such problems occur.METHODS: This qualitative study used the focus group interview method. Thirteen study participants included five home-visit tutors, five insurance salespersons, and three credit card recruiters. The interviews were conducted from November 2018 through January 2019, with each occupational group interview lasting about 2 hours. Analysis based on phenomenological research was independently performed by two researchers.RESULTS: Most participants had common health problems involving vocal cord symptoms, and stress related to emotional labor and traffic accidents. The unique health problems included cystitis, musculoskeletal, and digestive symptoms in home-visit tutors; reduced vision and hearing in insurance salespersons; and mental distress in credit card recruiters. There was no protection system for their health coverage, and the company emphasized their self-employed status to avoid taking responsibility for them. Twelve participants did not purchase occupational accident insurance owing to both not having adequate information and economic burden concerning premium status.CONCLUSION: WSER experienced both physical and mental health problems. These problems were caused by their unstable employment status, and the social security system for their coverage being non-functioning.
Accidents, Occupational ; Accidents, Traffic ; Cystitis ; Employment ; Focus Groups ; Hearing ; Humans ; Insurance ; Mental Health ; Methods ; Occupational Groups ; Occupational Health ; Qualitative Research ; Social Security ; Vision, Low ; Vocal Cords

OBJECTIVES: This study compared the socioeconomic status, medical use and expenditures for infants (1–5 years), juveniles (6–12 years), and adolescents (13–19 years) with a chronic condition or disease to determine factors affecting health spending.METHODS: Data from 3,677 minors (< 20 years old, without disabilities) were extracted from the Korea Health Panel (2015) database.RESULTS: Minors with chronic conditions or diseases were older (juveniles, and adolescents; p < 0.001), and included a higher proportion of Medicaid recipients (p = 0.004), a higher use of hospital outpatient care (p < 0.001), and higher medical expenditure (p < 0.001) compared to minors without chronic conditions or diseases. Boys were more likely to have a chronic condition or disease than girls (p = 0.036). Adolescents and juveniles were more likely than infants to have a chronic condition or disease (p = 0.001). Medicaid recipients were more likely to have a chronic condition or disease than those who were not Medicaid recipients (p = 0.008). Minors who had been hospital outpatients were more likely to have a chronic condition or disease, compared with minors who had not been an outpatient (p = 0.001). Having a chronic condition or disease, was a factor increasing medical expenditure (p = 0.001). Medical expenditure was higher in infants than in juveniles and adolescents (p = 0.001). Infants had higher rates of medical use when compared with juveniles and adolescents (p = 0.001).CONCLUSION: These findings suggest that systematic health care management for minors with chronic conditions or diseases, is needed.
Adolescent ; Ambulatory Care ; Chronic Disease ; Delivery of Health Care ; Female ; Health Expenditures ; Humans ; Infant ; Korea ; Medicaid ; Outpatients ; Social Class