Cervical Intraepithelial Neoplasia ; Early Detection of Cancer ; Gynecology ; Human Papillomavirus DNA Tests ; Humans ; Korea ; Mass Screening ; Medical Overuse ; Methods ; Obstetrics ; Prevalence ; Uterine Cervical Neoplasms

Background: As the Philippines moves toward universal health coverage, it is imperative to examine how to eliminate inefficiencies, particularly misuse, overutilization, and risks of fraudulent claims. This position statement aimed to identify health services requiring copayments for cost-efficient health financing for the Universal Health Care Act. Methods: A qualitative study was employed using a systematic review of literature, and thematic analysis of policy roundtable discussion (RTD) was conducted. The systematic review of literature generated evidence for the policy brief and critical points for discussion in the stakeholders’ RTD forum. The RTD was organized by the UP Manila Health Policy Development Hub (UPM HPDH) with the Department of Health (DOH) and was participated by key stakeholders of the policy issue to attain consensus recommendations and develop criteria for identifying services requiring copayments. Results: An algorithm is proposed by the UPM HPDH based on collective expertise as a guide for policymakers to assess each benefit package in terms of overutilization, the danger of depleting government funds, and the risk of fraud. The use of clinical pathways is suggested to assess the misuse and overutilization of health services. In addition to copayments, benefits packages prone to fraudulent activities should be subjected to fraud prevention processes. Copayment should be linked inversely to the preventability level of the disease or condition. Conclusion There were gaps in the current policies to identify services requiring copayment services. Copayment schemes should be carefully determined to prevent misuse, overuse, and fraud of appropriate and necessary health services, while at the same time not limit access to needed care.
Universal Health Insurance ; Cost Sharing ; Medical Overuse

Recently, the prevalence of prostate cancer has been increased with the screening of prostate-specific antigen and the increase in the elderly population. In particular, the diagnosis of the low-risk prostate cancer has increased greatly, and social interest for overtreatment has been heightened in Korea. Therefore, this review aimed to provide evidence-based treatment guidelines in low-risk prostate cancer based on Korean population. The literature provides evidence on treatment options, such as watchful waiting, active surveillance, radical prostatectomy, and radiation therapy according to the life expectancy of patients with low-risk prostate cancer. Furthermore, this review provides information on the efficacy of pelvic lymph node dissection and adjuvant radiation therapy during/after radical prostatectomy in low-risk prostate cancer.
Aged ; Diagnosis ; Evidence-Based Medicine ; Humans ; Korea ; Life Expectancy ; Lymph Node Excision ; Mass Screening ; Medical Overuse ; Neoplasms, Second Primary ; Prevalence ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Watchful Waiting

Angiomatoid Spitz nevus is a variant of melanocytic nevus with prominent vasculature. Due to its pathologic features, angiomatoid Spitz nevus in the vaginal wall is extremely rare. A 42-year-old woman presented to the hospital with abnormal vaginal bleeding. Vaginal examination revealed a 2×2-cm well-demarcated tumor on the posterior wall of the vagina. The mass was successfully removed by complete excision and was diagnosed as angiomatoid Spitz nevus on pathologic examination. We present the first reported case of vaginal angiomatoid Spitz nevus, which caused vaginal bleeding. Although angiomatoid Spitz nevus has many histopathological similarities with malignant melanoma, precise histopathological diagnosis is important for preventing overtreatment.
Adult ; Diagnosis ; Female ; Gynecological Examination ; Humans ; Medical Overuse ; Melanoma ; Nevus, Epithelioid and Spindle Cell ; Nevus, Pigmented ; Uterine Hemorrhage ; Vagina

The guidelines for chronic obstructive pulmonary disease (COPD) treatment are important for the management of the disease. However, studies regarding the treatment adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have been scarce in Korea. Therefore, to examine the adherence to the GOLD guidelines, we examined the patterns of prescribed medication in COPD patients from 2011 to 2018. Patients were classified as having been appropriately and inappropriately treated (overtreatment or undertreatment) for the GOLD group. Appropriate medical therapy was defined as using the first choice or alternative choice drug recommended in the GOLD guidelines. Inappropriate therapy was classified as overtreatment or undertreatment in accordance with the categorization in the GOLD guidelines. According to treatment of 2011 GOLD guidelines, there was inappropriate treatment in 52.3% in group A, 47.3% in group B, 56.3% in group C, and 17.8% in group D. According to treatment of 2017 GOLD guidelines, there was inappropriate treatment in 66.7% in group A, 45.3% in group B, 14.3% in group C, and 24.0% in group D. The common type of inappropriate COPD treatment is overtreatment, with inhaled corticosteroid (ICS) containing regimens. In conclusions, adherence to the GOLD guideline by the pulmonologist in clinical practice is still low in Korea. Therefore, we need better strategies to both optimize the use of the guidelines and adhere to the guidelines as well.
Humans ; Korea* ; Lung Diseases ; Medical Overuse ; Pulmonary Disease, Chronic Obstructive*

Lung cancer is a leading cause of cancer death worldwide. The effectiveness of lung cancer targeted high-risk population using low dose chest computed tomography has been reported several randomized controlled trials. Thus, recently, lung cancer screening to high-risk group is recommended internationally. National Cancer Center reported a lung cancer screening guideline by evidence-based methods in 2015. Korean national lung cancer screening program started from 2019 after evaluation of Korean lung cancer screening demonstration project (K-LUCAS) nationwide. K-LUCAS obtained comparable high early lung cancer detection rate, lower false positive rate and lower complication rate compared with clinical trials conducted in other countries. Also psychological anxiety of screening participants had been low, but willingness of smoking cessation had been increased after screening. This paper will review the evidence of lung cancer screening from clinical trials, also, evaluate the benefits and harms of screening based on K-LUCAS.
Anxiety ; Korea ; Lung Neoplasms ; Lung ; Mass Screening ; Medical Overuse ; Smoking Cessation ; Thorax

OBJECTIVE: To investigate the effects of different types of mammography equipment on screening outcomes by comparing the performance of film-screen mammography (FSM), computed radiography mammography (CRM), and digital mammography (DM).MATERIALS AND METHODS: We retrospectively enrolled 128756 sets of mammograms from 10 hospitals participating in the Alliance for Breast Cancer Screening in Korea between 2005 and 2010. We compared the diagnostic accuracy of the types of mammography equipment by analyzing the area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI); performance indicators, including recall rate, cancer detection rate (CDR), positive predictive value₁ (PPV₁), sensitivity, specificity, and interval cancer rate (ICR); and the types of breast cancer pathology.RESULTS: The AUCs were 0.898 (95% CI, 0.878–0.919) in DM, 0.860 (0.815–0.905) in FSM, and 0.866 (0.828–0.903) in CRM (p = 0.150). DM showed better performance than FSM and CRM in terms of the recall rate (14.8 vs. 24.8 and 19.8%), CDR (3.4 vs. 2.2 and 2.1 per 1000 examinations), PPV₁ (2.3 vs. 0.9 and 1.1%), and specificity (85.5 vs. 75.3 and 80.3%) (p < 0.001) but not in terms of sensitivity (86.3 vs. 87.4 and 86.3%) and ICR (0.6 vs. 0.4 and 0.4). The proportions of carcinoma in situ (CIS) were 27.5%, 13.6%, and 11.8% for DM, CRM, and FSM, respectively (p = 0.003).CONCLUSION: In comparison to FSM and CRM, DM showed better performance in terms of the recall rate, CDR, PPV₁, and specificity, although the AUCs were similar, and more CISs were detected using DM. The application of DM may help to improve the quality of mammography screenings. However, the overdiagnosis issue of CIS using DM should be evaluated.
Area Under Curve ; Breast Neoplasms ; Breast ; Carcinoma in Situ ; Korea ; Mammography ; Mass Screening ; Medical Overuse ; Pathology ; Radiography ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. Histologically, squamous metaplasia has been reported in PA, but has rarely been documented as being extensive enough to cause significant misdiagnosis. Here, we present an unusual case of PA in a 50-year-old female patient presenting with swelling on the postero-lateral aspect of the palate for a week. Histopathologically, the tumor exhibited the features of conventional PA with extensive squamous metaplasia and giant keratotic lamellae in cyst-like areas. Such exuberant squamous metaplasia and keratin can be a diagnostic and prognostic pitfall and lead to overtreatment of the patient.
Adenoma, Pleomorphic ; Diagnostic Errors ; Female ; Humans ; Medical Overuse ; Metaplasia ; Middle Aged ; Palate ; Pathology ; Salivary Glands

While overtreatment in medical services had been the topic of interest among the medical community for a long time, there are numerous academic papers concerning over-diagnosis nowadays. The use of imaging studies for screening might lead to over-diagnosis of small renal masses (SRMs) therefore the incidence of kidney cancer increased 5 times higher than that of mortality in Korea between 2000 and 2011. The best treatment for SRMs had been debated and the present strategies include surgery, local treatment, and active surveillance. Competing risks to mortality should be considered to determine initial management strategies, and a period of initial active surveillance in patients with SRMs is safe. Tumor growth rate is the primary driver for delayed intervention of SRMs patients, and the risk of metastasis on active surveillance for SRMs is 1%–2% at 2-year follow-up.
Follow-Up Studies ; Humans ; Incidence ; Kidney Neoplasms ; Kidney ; Korea ; Mass Screening ; Medical Overuse ; Mortality ; Neoplasm Metastasis

The emergence of mucosal healing as a treatment goal that could modify the natural course of Crohn's disease and the accumulating evidence showing that biologics are most effective in achieving mucosal healing, along with the success of early treatment regimens for rheumatoid arthritis, have led to the identification of early Crohn's disease and development of the concept of catching the therapeutic window during the early disease course. Thus, an increasing number of pediatric gastroenterologists are adopting an early biologic treatment strategy with or without an immunomodulator. Although early biologic treatment is effective, cost and overtreatment are issues that limit its early use. Currently, there are insufficient data on who will benefit most from early biologics, as well as on who will not need early or even any biologics. For now, top-down biologics should be considered for patients with currently known high-risk factors of poor outcomes. For other patients, close, objective monitoring and accelerating the step-up process by means of a treat-to-target approach seems the best way to catch the therapeutic window in early pediatric Crohn's disease. The individual benefits of immunomodulator addition during early biologic treatment should be weighed against its risks and decision on early combination treatment should be made after comprehensive discussion with each patient and guardian.
Arthritis, Rheumatoid ; Biological Products ; Crohn Disease ; Humans ; Medical Overuse ; Pediatrics