This article reviewed achievements and challenges of the National Health Insurance of the Republic of Korea and shared thoughts on its future directions. Starting with large workplaces of 500 or more employees in 1977, Korea's National Health Insurance successfully achieved universal coverage within just 12 yr in 1989. This amazing pace of growth was possible due to a positive combination of strong political will and rapid economic growth. Key features of Korea's experience in achieving universal coverage include 1) gradual expansion of coverage, 2) careful consideration to maintain sound insurance finances, and 3) introducing multiple health insurance societies (multiple payer system) at the initial stage. Introduction of the health insurance has dramatically improved Korea's health indicators and has fueled the rapid growth of basic medical infrastructure including medical institutions and professionals. On the other hand, the successful expansion was not free from side-effects. Although coverage has gradually expanded, benefits are still relatively low. The current situation warrants concern because coverage expansion is driven by welfare populism asserted by irresponsible political slogans and lacks a social consensus on basic principles and philosophy regarding the expansion. Concentration of patients to a few large prestigious hospitals as well as the inefficiencies resulting from a colossal single-payer system should also be pointed out.
Delivery of Health Care/*economics ; Humans ; National Health Programs/*economics ; Republic of Korea ; Social Welfare

No abstract available.
Quality of Life* ; Surveys and Questionnaires*

No abstract available.
Glycogen Storage Disease Type II* ; Wolff-Parkinson-White Syndrome*

Spinal paragonimiasis is an uncommon ectopic manifestation of the lung fluke. In this paper eight cases of spinal paragonimiasis treated in the Severance Hospital are reported and the literature is reviewed. Differantial diagnosis is usually difficult because of the similarity of symptoms and signs with benign spinal cord tumors. positive chest X-ray findings, positive skin test and pleocytosis of the spinal fluid, especially of eosinsphils, are valuable findings in the diagnosis. The extradural space in the 1ower thoracic region is the most frequently affected area. Laminectomy with excision of the lesion supported by chemotherapy is the treatment of choice. When treated early, prognosis of this type of manfestation is usually favorable.

Distal myopathy with rimmed vacuoles is a rare muscle disease and, so far as we know, it has not been reported in Korea as yet. This disorder is known to be inherited as autosomal recessive trait and to have no specific treatment. Hereby, we report 3 patients of distal myopathy with rimmed vacuoles in a family. The clinical characteristics of these patients were slowly progressive symmetrical muscle weakness and wasting of all 4 extremities, worse in distal legs. The pretibial muscles were involved more markedly than the calf muscles. Serum muscle enzymes were increased. The prominent EMG findings were myopathic changes, but reduced recruitment was occasionally found in some distal muscles The muscle biopsies of right biceps brachii muscle were performed in two patients, which showed the characteristic rimmed vacuoles by light microscope. Membranous whorls and randomly oriented intracytoplasmic filaments were found by electron microscope. The severity of pathological abnormalities were related to the clinical status of the patient. One had been treated with steroid(prednisolone) for several years but with no improvement.
Biopsy ; Distal Myopathies* ; Extremities ; Humans ; Korea ; Leg ; Muscle Weakness ; Muscles ; Vacuoles*

No abstract available.
Extremities* ; Liposarcoma*

No abstract available.
Emergencies* ; Emergency Service, Hospital* ; Hospitals, Teaching* ; Korea* ; Medical Records*

BACKGROUND: Medication adherence (MA) is poor among patients with chronic illnesses, such as those involving the risk factors of stroke. However, the impacts of poor MA on the modifiable risk factors of stroke are not well known. METHODS: We evaluated the MA for the control of hypertension, diabetes, hyperlipidemia, and previous ischemic stroke among consecutive patients with ischemic stroke within 7 days of symptom onset. Nonadherence was defined as taking doctor-prescribed medications for less than 3 weeks during the previous month. Demographic data, risk factor profile, stroke mechanism, and baseline score on the National Institutes of Health Stroke Scale (NIHSS) were compared among patients with nonadherence and those without. RESULTS: Among 1133 patients with at least one medicated risk factor, the rates of nonadherence in hypertension, diabetes, hyperlipidemia, and previous ischemic stroke were 18.5%, 15.3%, 30.3%, and 28.1%, respectively. Overall, 27.4% of patients with more than one risk factor presented nonadherence, with a predilection toward being male (male, 63.9% vs. female, 56.1%, p=0.02) and younger (mean age 64.9 years vs. 66.4 years, p=0.01). Stroke severity according to MA did not differ using either crude analysis (NIHSS score: 5.5+/-5.9 vs. 5.4+/-5.5, p=0.71) or multivariable analysis after log transformation. The prevalence of nonadherence was low for large-artery disease and small-vessel occlusion, and high for cardioembolism. CONCLUSIONS: Prestroke poor MA for the major risk factors was common among patients with chronic illnesses, and was more frequent in younger male patients. Stroke severity was not affected by MA during the month preceding stroke.
Chronic Disease ; Female ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Medication Adherence ; National Institutes of Health (U.S.) ; Prevalence ; Risk Factors ; Stroke

The prevalence of right-sided infective endocarditis is increasing with a growing number of intravenous drug abusers. A case of right-sided endocarditis is reported in a 18-year-old female heroin addict. Tricuspid valve vegetation, septic pulmonary emboli and staphyloccus aureus in blood cultures are noted. During antimicrobial therapy, she developed remittent fever and skin rash due to vancomycin. After a change of the antibiotic to teicoplanin, she was freed from fever and discharged in an improved condition.
Adolescent ; Drug Users ; Endocarditis* ; Exanthema ; Female ; Fever ; Heroin ; Humans ; Malaria ; Prevalence ; Pulmonary Embolism* ; Teicoplanin ; Tricuspid Valve* ; Vancomycin

OBJECTIVE: To determine the effect of functional electrical stimulation (FES) in the paralyzed muscles of rabbits with spinal cord injury (SCI). METHOD: Fifteen male New Zealand white rabbits were injured by spinal cord transection at the T6 level. We classified animals into a normal control group (n=3), and SCI without FES (n=3), SCI with 10 Hz FES (n=6) and SCI with 40 Hz FES (n=6) groups. FES was applied on both tibialis anterior (TA) muscles at two frequencies (10 Hz, 40 Hz) for 1 hour daily for 2 weeks. After treatment TA muscles were separated and apoptotic features were measured by in situ DNA nick-end labeling (TUNEL), DNA fragmentation assays and western blotting for Bcl-2and Bax protein. RESULTS: In TUNEL and DNA fragmentation assay results, the FES groups showed more fragmented myonuclei and DNA, and western blotting showed more Bax protein expression in FES groups than no FES group and control (higher in 40Hz group), whereas Bcl-2 protein expressions were similar in all groups. CONCLUSION: Apoptosis of paralyzed muscle was increased in FES group with higher Bax/Bcl-2 in 40 Hz than in 10 Hz. To evaluate the clinical significance of muscle apoptosis with FES in SCI, further study would be needed.
Animals ; Apoptosis* ; bcl-2-Associated X Protein ; Blotting, Western ; DNA ; DNA Fragmentation ; Electric Stimulation* ; Humans ; In Situ Nick-End Labeling ; Male ; Muscles ; Rabbits ; Spinal Cord Injuries* ; Spinal Cord*