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*

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: 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

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: 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 ;

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: The objective of this study was to investigate whether financial coverage by the national insurance system for patients with lower economic conditions can improve their 1-year mortality after intensive care unit (ICU) discharge. MATERIALS AND METHODS: This study, conducted in a single tertiary hospital, used a retrospective cohort design to investigate discharged ICU survivors between January 2012 and December 2016. ICU survivors were classified into two groups according to the National Health Insurance (NHI) system in Korea: medical aid program (MAP) group, including people who have difficulty paying their insurance premium or receive medical aid from the government due to a poor economic status; and NHI group consisting of people who receive government subsidy for approximately 2/3 of their medical expenses. RESULTS: After propensity score (PS) matching, a total of 2495 ICU survivors (1859 in NHI group and 636 in MAP group) were included in the analysis. Stratified Cox regression analysis of PS-matched cohorts showed that 1-year mortality was 1.31-fold higher in MAP group than in NHI group (hazard ratio: 1.31, 95% confidence interval, 1.06 to 1.61; p=0.012). According to Kaplan-Meir estimation, MAP group also showed significantly poorer survival probability than NHI group after PS matching (p=0.011). CONCLUSION: This study showed that 1-year mortality was higher in ICU survivors with low economic status, even if financial coverage was provided by the government. Our result suggests the necessity of a more nuanced and multifaceted approach to policy for ICU survivors with low economic status.
Cohort Studies ; Critical Care ; Financing, Government ; Humans ; Insurance ; Intensive Care Units ; Korea ; Mortality ; National Health Programs ; Propensity Score ; Retrospective Studies ; Survivors ; Tertiary Care Centers

BACKGROUND: The aim of this study was to describe the types of diseases that developed in semiconductor workers who have registered with the Korea Workers' Compensation and Welfare Service (KWCWS) and to identify potential common occupational characteristics by the type of claimed disease. METHODS: A total of 55 semiconductor workers with cancer or rare diseases who claimed to the KWCWS were compared based on their work characteristics and types of claimed diseases. Leukemia, non-Hodgkin lymphoma, and aplastic anemia were grouped into lymphohematopoietic (LHP) disorder. RESULTS: Leukemia (n = 14) and breast cancer (n = 10) were the most common complaints, followed by brain cancer (n = 6), aplastic anemia (n = 6), and non-Hodgkin lymphoma (n = 4). LHP disorders (n = 24) accounted for 43%. Sixty percent (n = 33) of registered workers (n = 55) were found to have been employed before 2000. Seventy-six percent (n = 42) of registered workers and 79% (n = 19) among the registered workers with LHP (n = 24) were found to be diagnosed at a relatively young age, ≤40 years. A total of 18 workers among the registered semiconductor workers were finally determined to deserve compensation for occupational disease by either the KWCWS (n = 10) or the administrative court (n = 8). Eleven fabrication workers who were compensated responded as having handled wafers smaller than eight inches in size. Eight among the 18 workers compensated (44 %) were found to have ever worked at etching operations. CONCLUSION: The distribution of cancer and rare diseases among registered semiconductor workers was closely related to the manufacturing era before 2005, ≤8 inches of wafer size handled, exposure to clean rooms of fabrication and chip assembly operations, and etching operations.
Anemia, Aplastic ; Brain Neoplasms ; Breast Neoplasms ; Compensation and Redress ; Environment, Controlled ; Korea ; Leukemia ; Lymphoma, Non-Hodgkin ; Occupational Diseases ; Rare Diseases ; Semiconductors ; Workers' Compensation

Work-related asthma is the most common occupational lung disease encountered in clinical practice. In adult asthmatics, work-relatedness can account for 15%–33% of cases, but delays in diagnosis remain common and lead to worse outcomes. Accurate diagnosis of asthma is the first step to managing occupational asthma, which can be sensitizer-induced or irritant-induced asthma. While latency has traditionally been recognized as a hallmark of sensitizer-induced asthma and rapid-onset a defining feature of irritant-induced asthma (as in Reactive Airway Dysfunction Syndrome), there is epidemiological evidence for irritant-induced asthma with latency from chronic moderate exposure. Diagnostic testing while the patient is still in the workplace significantly improves sensitivity. While specific inhalational challenges remain the gold-standard for the diagnosis of occupational asthma, they are not available outside of specialized centers. Commonly available tests including bronchoprovocation challenges and peak flow monitoring are important tools for practicing clinicians. Management of sensitizer-induced occupational asthma is notable for the central importance of removal from the causative agent: ideally, removal of the culprit agent; but if not feasible, this may require changes in the work process or ultimately, removal of the worker from the workplace. While workers' compensation programs may reduce income loss, these are not universal and there can be significant socio-economic impact from work-related asthma. Primary prevention remains the preferred method of reducing the burden of occupational asthma, which may include modification to work processes, better worker education and substitution of sensitizing agents from the workplace with safer compounds.
Adult ; Asthma ; Asthma, Occupational ; Case Management ; Diagnosis ; Diagnostic Tests, Routine ; Education ; Humans ; Lung Diseases ; Methods ; Primary Prevention ; Workers' Compensation

OBJECTIVES: Home-based nursing care services have increased over the past decade. However, accountability and privacy issues as well as security concerns become more challenging during care provider visits. Because of the heterogeneous combination of mobile and stationary assistive medical care devices, conventional systems lack architectural consistency, which leads to inherent time delays and inaccuracies in sharing information. The goal of our study is to develop an architecture that meets the competing goals of accountability and privacy and enhances security in distributed home-based care systems. METHODS: We realized this by using a context-aware approach to manage access to remote data. Our architecture uses a public certification service for individuals, the Japanese Public Key Infrastructure and Health Informatics-PKI to identify and validate the attributes of medical personnel. Both PKI mechanisms are provided by using separate smart cards issued by the government. RESULTS: Context-awareness enables users to have appropriate data access in home-based nursing environments. Our architecture ensures that healthcare providers perform the needed home care services by accessing patient data online and recording transactions. CONCLUSIONS: The proposed method aims to enhance healthcare data access and secure information delivery to preserve user's privacy. We implemented a prototype system and confirmed its feasibility by experimental evaluation. Our research can contribute to reducing patient neglect and wrongful treatment, and thus reduce health insurance costs by ensuring correct insurance claims. Our study can provide a baseline towards building distinctive intelligent treatment options to clinicians and serve as a model for home-based nursing care.
Asian Continental Ancestry Group ; Certification ; Computer Security ; Delivery of Health Care ; Electronic Health Records ; Health Information Exchange ; Health Personnel ; Health Smart Cards ; Home Care Services ; Home Health Nursing ; Humans ; Information Dissemination ; Insurance ; Insurance, Health ; Methods ; Nursing ; Nursing Care ; Privacy ; Social Responsibility