Catastrophic healthcare expenditure refers to out-of-pocket spending for healthcare exceeding a certain proportion of a household's income and can lead to subsequent impoverishment. The aim of this study was to investigate the proportion of South Korean households that experienced catastrophic healthcare expenditure between 2006 and 2015 using available data from the Korea Health Panel, National Survey of Tax and Benefit, and Household Income and Expenditure Survey. Frequencies and trend tests were conducted to analyze the proportion of households with catastrophic healthcare expenditure. Subgroup analysis was performed based on income level. The results of the Household Income and Expenditure Survey revealed that around 2.88% of households experienced catastrophic healthcare expenditure in 2015 and that this proportion was highest in the low income group. Results also showed a statistically significant increasing trend in the number of households with catastrophic healthcare expenditure (annual percentage change=0.92%, p-value <0.0001). Therefore, the findings infer a need to strengthen public health care financing and to particularly monitor catastrophic healthcare expenditure in the low income group.
Delivery of Health Care ; Family Characteristics ; Health Expenditures* ; Korea* ; Public Health ; Taxes

Background: The Korean government introduced National Cancer Control Program and strengthening national health insurance coverage for cancer patients. Although many positive effects have been observed, there are also many concerns about cancer management such as patient concentration or time-to-treatment. Thus, we investigated the association between the time-to-treatment and survival of cancer patients, and compared regional differences by time trend. Methods: The data used in this study were national health insurance claims data that included patients diagnosed with lung cancer and received surgical treatment between 2005 and 2015. We conducted survival analysis with Cox proportional hazard model for the association between time-to-treatment and survival in lung cancer. Additionally, we compared the regional differences for time-to-treatment by time trend. Results: A total of 842 lung cancer patients were included, and 52.3% of lung cancer patients received surgical treatment within 30 days. Patients who received surgical treatment after 31 days had higher 5-year or 1-year mortality compared to treatment within 30 days (5-year: hazard ratio [HR], 1.566; 1-year: HR, 1.555; p<0.05). There were some regional differences for time-to-treatment, but it was generally reduced after 2010. Conclusion Delayed surgical treatment after diagnosis can negatively affect patient outcomes in cancer treatment. To improve cancer control strategies, there are needed to analyze the healthcare delivery system for cancer care considering the severity and types of cancer.

Background: The Korean government introduced National Cancer Control Program and strengthening national health insurance coverage for cancer patients. Although many positive effects have been observed, there are also many concerns about cancer management such as patient concentration or time-to-treatment. Thus, we investigated the association between the time-to-treatment and survival of cancer patients, and compared regional differences by time trend. Methods: The data used in this study were national health insurance claims data that included patients diagnosed with lung cancer and received surgical treatment between 2005 and 2015. We conducted survival analysis with Cox proportional hazard model for the association between time-to-treatment and survival in lung cancer. Additionally, we compared the regional differences for time-to-treatment by time trend. Results: A total of 842 lung cancer patients were included, and 52.3% of lung cancer patients received surgical treatment within 30 days. Patients who received surgical treatment after 31 days had higher 5-year or 1-year mortality compared to treatment within 30 days (5-year: hazard ratio [HR], 1.566; 1-year: HR, 1.555; p<0.05). There were some regional differences for time-to-treatment, but it was generally reduced after 2010. Conclusion Delayed surgical treatment after diagnosis can negatively affect patient outcomes in cancer treatment. To improve cancer control strategies, there are needed to analyze the healthcare delivery system for cancer care considering the severity and types of cancer.

Few studies have included magnetoencephalography (MEG) when assessing the diagnostic value of presurgical modalities in a nonlesional epilepsy population. Here, we compare single photon emission computed tomography (SPECT), positron emission tomography (PET), video-EEG (VEEG), and MEG, with intracranial EEG (iEEG) to determine the value of individual modalities to surgical decisions. We analyzed 23 adult epilepsy patients with no abnormal MRI findings who had undergone surgical resection. Localization of individual presurgical tests was determined for hemispheric and lobar locations based on visual analysis. Each localization result was compared with the ictal onset zone (IOZ) defined by using iEEG. The highest to the lowest hemispheric concordance rates were MEG (83%) > ictal VEEG (78%) > PET (70%) > ictal SPECT (57%). The highest to lowest lobar concordance rates were ictal VEEG = MEG (65%) > PET (57%) > ictal SPECT (52%). Statistical analysis showed MEG to have a higher hemispheric concordance than that of ictal SPECT (P = 0.031). We analyzed the effects of MEG clustered-area resection on surgical outcome. Patients who had resection of MEG clusters showed a better surgical outcome than those without such resection (P = 0.038). It is suggested that MEG-based localization had the highest concordance with the iEEG-defined IOZ. Furthermore, MEG cluster resection has prognostic significance in predicting surgical outcome.
Adolescent ; Adult ; Brain/*pathology/surgery ; *Brain Mapping ; Electroencephalography ; Epilepsy/*radionuclide imaging/surgery ; Female ; Humans ; Magnetic Resonance Imaging ; *Magnetoencephalography ; Male ; Middle Aged ; Positron-Emission Tomography ; Preoperative Care ; Tomography, Emission-Computed, Single-Photon ; Video Recording

Few studies have included magnetoencephalography (MEG) when assessing the diagnostic value of presurgical modalities in a nonlesional epilepsy population. Here, we compare single photon emission computed tomography (SPECT), positron emission tomography (PET), video-EEG (VEEG), and MEG, with intracranial EEG (iEEG) to determine the value of individual modalities to surgical decisions. We analyzed 23 adult epilepsy patients with no abnormal MRI findings who had undergone surgical resection. Localization of individual presurgical tests was determined for hemispheric and lobar locations based on visual analysis. Each localization result was compared with the ictal onset zone (IOZ) defined by using iEEG. The highest to the lowest hemispheric concordance rates were MEG (83%) > ictal VEEG (78%) > PET (70%) > ictal SPECT (57%). The highest to lowest lobar concordance rates were ictal VEEG = MEG (65%) > PET (57%) > ictal SPECT (52%). Statistical analysis showed MEG to have a higher hemispheric concordance than that of ictal SPECT (P = 0.031). We analyzed the effects of MEG clustered-area resection on surgical outcome. Patients who had resection of MEG clusters showed a better surgical outcome than those without such resection (P = 0.038). It is suggested that MEG-based localization had the highest concordance with the iEEG-defined IOZ. Furthermore, MEG cluster resection has prognostic significance in predicting surgical outcome.
Adolescent ; Adult ; Brain/*pathology/surgery ; *Brain Mapping ; Electroencephalography ; Epilepsy/*radionuclide imaging/surgery ; Female ; Humans ; Magnetic Resonance Imaging ; *Magnetoencephalography ; Male ; Middle Aged ; Positron-Emission Tomography ; Preoperative Care ; Tomography, Emission-Computed, Single-Photon ; Video Recording

OBJECTIVE: The aim of this study was to devise an objective clustering method for magnetoencephalography (MEG) interictal spike sources, and to identify the prognostic value of the new clustering method in adult epilepsy patients with cortical dysplasia (CD). METHODS: We retrospectively analyzed 25 adult patients with histologically proven CD, who underwent MEG examination and surgical resection for intractable epilepsy. The mean postoperative follow-up period was 3.1 years. A hierarchical clustering method was adopted for MEG interictal spike source clustering. Clustered sources were then tested for their prognostic value toward surgical outcome. RESULTS: Postoperative seizure outcome was Engel class I in 6 (24%), class II in 3 (12%), class III in 12 (48%), and class IV in 4 (16%) patients. With respect to MEG spike clustering, 12 of 25 (48%) patients showed 1 cluster, 2 (8%) showed 2 or more clusters within the same lobe, 10 (40%) showed 2 or more clusters in a different lobe, and 1 (4%) patient had only scattered spikes with no clustering. Patients who showed focal clustering achieved better surgical outcome than distributed cases (p=0.017). CONCLUSION: This is the first study that introduces an objective method to classify the distribution of MEG interictal spike sources. By using a hierarchical clustering method, we found that the presence of focal clustered spikes predicts a better postoperative outcome in epilepsy patients with CD.
Adult ; Epilepsy ; Follow-Up Studies ; Humans ; Magnetoencephalography ; Malformations of Cortical Development ; Retrospective Studies ; Seizures

Catastrophic health expenditure refers to when a household spends more than 40 percent of disposable income for out-of-pocketexpenses for healthcare. This study investigates the percentage of South Korean household which experienced the catastrophic health expenditure between 2006 and 2016 with the National Survey of Tax and Benefit and the Household Income and Expenditure Survey data. Percentage of households with the catastrophic health expenditure and tread tests were conducted with weight variable. The results of the National Survey of Tax and Benefit and the Household Income and Expenditure Survey showed 2.17% and 2.92% of households experienced the catastrophic health expenditure in 2016. In trend analysis, the National Survey of Tax and Benefit showed a statistically significant decreasing trend in the proportion of households with the catastrophic health expenditure (annual percentage change [APC]=−4.03, p < 0.0001). However, the Household Income and Expenditure Survey revealed a statistically significant increasing trend (APC=1.43, p < 0.0001). In conclusion, this study suggests that optimal healthcare alternatives are needed for the catastrophic health expenditure and monitoring low-income households.
Delivery of Health Care ; Family Characteristics ; Health Expenditures ; Korea ; Taxes

PURPOSE: The purpose of this study was to conduct a cost effectiveness analysis of strategies designed to improve national cervical cancer screening rates, along with a distributional cost effectiveness analysis that considers regional disparities. MATERIALS AND METHODS: Cost effectiveness analysis was conducted using a Markov cohort simulation model, with quality adjusted life years as the unit of effectiveness. The strategies considered were current (biennial Papanicolaou smear cytology of females aged 20 or above), strong screening recommendation by mail to target regions (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person), regular universal screening recommendation by mail (effect, 6% increase in screening uptake; cost, 500 Korean won per person), and strong universal screening recommendation by mail (effect, 12% increase in screening uptake; cost, 1,000 Korean won per person). Distributional cost effectiveness analysis was conducted by calculating the cost effectiveness of strategies using the Atkinson incremental cost effectiveness ratio. RESULTS: All strategies were under the threshold value, which was set as the Korean gross domestic product of $25,990. In particular, the ‘strong screening recommendation to target regions’ strategy was found to be the most cost effective (incremental cost effectiveness ratio, 7,361,145 Korean won). This was also true when societal inequality aversion increased in the distributional cost effectiveness analysis. CONCLUSION: The ‘strong screening recommendation to target regions’ strategy was the most cost effective approach, even when adjusting for inequality. As efficiency and equity are objectives concurrently sought in healthcare, these findings imply a need to develop appropriate economic evaluation methodologies to assess healthcare policies.
Cohort Studies ; Cost-Benefit Analysis ; Delivery of Health Care ; Early Detection of Cancer ; Female ; Gross Domestic Product ; Healthcare Disparities ; Humans ; Korea ; Mass Screening ; Papanicolaou Test ; Postal Service ; Quality-Adjusted Life Years ; Socioeconomic Factors ; Uterine Cervical Neoplasms

Purpose: Chronic diseases and cardiovascular diseases (CVD) have been independently linked to poorer cancer outcomes. This study investigated whether gastric cancer patients with hypertension, diabetes, or dyslipidemia have higher mortality if diagnosed with CVD in the past year before cancer diagnosis. Materials and Methods: Data were obtained from the National Health Insurance database for 2002 to 2019. The study population consisted of gastric cancer patients with hypertension, diabetes, or dyslipidemia. The outcome measure was 5-year mortality in relation to incident status of CVD within 1 year before cancer diagnosis. A survival analysis was conducted using the Cox proportional hazards model. Subgroup analysis was conducted according to age, economic status, and type of hospital first visited for cancer treatment. Results: Of a total of 6458 individuals, 2123 (32.7%) were diagnosed with CVDs in the past year before cancer diagnosis. Compared to participants without a history of CVD, those who were diagnosed with CVD showed a higher risk of 5-year mortality (hazard ratio 1.259, 95% confidence interval 1.138–1.394). The extent to which the mortality risk differed between those with and without CVD was greater for individuals of low economic status and in those receiving their initial cancer treatment in a general hospital. Conclusion Patients with gastric cancer and hypertension, diabetes, or dyslipidemia diagnosed with CVD within 1 year before their cancer diagnosis had a higher mortality risk, emphasizing the importance of managing cancer patients with chronic disease and subsequent incidence of CVDs.

Purpose: Chronic diseases and cardiovascular diseases (CVD) have been independently linked to poorer cancer outcomes. This study investigated whether gastric cancer patients with hypertension, diabetes, or dyslipidemia have higher mortality if diagnosed with CVD in the past year before cancer diagnosis. Materials and Methods: Data were obtained from the National Health Insurance database for 2002 to 2019. The study population consisted of gastric cancer patients with hypertension, diabetes, or dyslipidemia. The outcome measure was 5-year mortality in relation to incident status of CVD within 1 year before cancer diagnosis. A survival analysis was conducted using the Cox proportional hazards model. Subgroup analysis was conducted according to age, economic status, and type of hospital first visited for cancer treatment. Results: Of a total of 6458 individuals, 2123 (32.7%) were diagnosed with CVDs in the past year before cancer diagnosis. Compared to participants without a history of CVD, those who were diagnosed with CVD showed a higher risk of 5-year mortality (hazard ratio 1.259, 95% confidence interval 1.138–1.394). The extent to which the mortality risk differed between those with and without CVD was greater for individuals of low economic status and in those receiving their initial cancer treatment in a general hospital. Conclusion Patients with gastric cancer and hypertension, diabetes, or dyslipidemia diagnosed with CVD within 1 year before their cancer diagnosis had a higher mortality risk, emphasizing the importance of managing cancer patients with chronic disease and subsequent incidence of CVDs.