ObjectivesThis study aimed to examine the factors associated with health services utilization using Andersen's behavioral model.MethodsWe collected Korea Health Panel data between the years 2010 and 2012 from the consortium of the National Health Insurance Service and the Korea Institute for Health and Social Affairs, and analyzed the data to determine the outpatients and inpatients of health services utilization.ResultsHealth services utilization was more significantly explained by predisposing and need factors than enabling factors. The outpatients were examined more specifically; sex, age, and marital status as predisposing factors, and chronic illness as a need factor were the variables that had significant effects on health-services-utilization experience. The inpatients were examined more specifically: sex, age, and marital status in predisposing factors; education level, economic activities, and insurance type in enabling factors; and chronic illness and disability status in need factors were the significant variables having greater effects on health-services-utilization experience.ConclusionThis study suggests the practical implications for providing health services for outpatients and inpatients. Moreover, verifying the general characteristics of outpatients and inpatients by focusing on their health services utilization provides the baseline data for establishing health service policies and programs with regard to the recently increasing interest in health services.

Nursing professionals, managers and health policy makers need to understand the factors influencing depressive symptoms and to use appropriate interventions based on the severity and not just the onset.

Traumatic brain injury (TBI), a global public health concern, may lead to death and major disability. While various short-term, small-sample, and cross-sectional studies on TBI have been conducted in South Korea, there is a lack of clarity on the nationwide longitudinal TBI trends in the country. This retrospective study investigated the epidemiological TBI trends in South Korea, using a population-based dataset of the National Health Insurance (2008–2017). The crude and age adjusted TBI incidence and mortality values were calculated and stratified by age, sex, and TBI diagnosis. The age-adjusted incidence per 100,000 people increased until 2010 and showed a decreasing trend (475.8 cases in 2017) thereafter; however, a continuously decreasing age-adjusted mortality trend was observed (42.9 cases in 2008, 11.3 in 2017). The crude incidence rate increased continually in those aged >70 years across all the TBI diagnostic categories. The mortality per 100,000 people was significantly higher among participants aged ≥70 years than in the other age groups. We observed changing trends in the TBI incidence, with a continuously decreasing overall incidence and a rapidly increasing incidence and high mortality values in older adults. Our findings highlight the importance of active TBI prevention in elderly people.

Although improvements in acute care for traumatic brain injury (TBI) have increased the patient survival rate, many survivors often suffer from neuropsychiatric sequelae such as depression. This study investigated the influence of TBI on the risk of depression using South Korean nationwide data. Data were extracted from the National Health Insurance Service database for patients who experienced TBI from 2010 to 2017 ( n = 1,141,593) and for 1:1 matched controls without TBI ( n = 1,141,593). Patients under 18 years old or with a history of depression were excluded. TBI was used as a time-varying exposure and a time-dependent Cox regression model was adopted. Age, sex, insurance premium and type, region of residence, past psychiatric diseases, and Charlson Comorbidity Index were adjusted. The incidence of depression in the patients with TBI and matched controls was 34.60 and 21.42 per 1000 person-years, respectively. The risk of depression was higher in the patients with TBI (hazard ratio [HR] 1.19, 95% confidence interval [CI] = 1.18-1.20) than in the matched control group. After stratification by sex and age, the risk was higher in men and the younger age group. In subgroup analyses, patients with skull fracture showed the highest risk of depression. Notably, during the first year after TBI, the depression risk was almost 11 times higher than that in the matched control group (HR 11.71, 95% CI = 11.54-11.87). Our findings highlight a significant association of TBI with an increased risk of subsequent depression. Therefore, continuous awareness with regard to patients' mental health is needed.

Recent changes in the medical paradigm highlight the importance of patient-centered communication. However, because of the lack of awareness of dental clinics and competency of medical personnel, the quality of medical services in terms of the communication between doctors and patients has not improved. This study analyzed the impact of health communication and medical service quality, service value, and patient satisfaction on the intention to revisit dental clinics. The study participants were outpatients treated at 10 dental clinics in Seoul. The research data were collected using a questionnaire during visits to these dental clinics from December 1 to December 30, 2016. A total of 600 questionnaires were distributed (60 copies to each clinics) and 570 valid questionnaires were used for the analysis. The influence of the factors was determined using structural equation modeling. The factors influencing service value were reliability (β = 0.364, p < 0.001), expertise (β = 0.319, p < 0.001), communication by doctors (β = 0.224, p < 0.001), and tangibility (β = 0.136, p < 0.05). In addition, the factors influencing patient satisfaction were reliability (β = 0.258, p < 0.001), tangibility (β = 0.192, p < 0.001), communication by doctors (β = 0.163, p < 0.001), and expertise (β = 0.122, p < 0.01). Further, service value (β = 0.438, p < 0.001) raised patient satisfaction, which was found to influence the intention to revisit dental clinics (β = 0.383, p < 0.001). Providing accurate medical services to inpatients based on smooth communication between doctors and patients improves patient satisfaction. In addition, doctors can build long-term relations with patients by increasing patients’ intention to revisit through patient-oriented communication.

Background To examine the incidence of traumatic spinal cord injury (TSCI) from all etiologies, we measured and compared the incidence of TSCI from three national or quasi-national databases in South Korea, namely, the National Health Insurance Service (NHIS), automobile insurance (AUI), and Industrial Accident Compensation Insurance (IACI). Methods We reviewed patients with TSCI reported in the NHIS database between 2009 and 2018, and in the AUI and IACI databases between 2014 and 2018. TSCI patients were defined as those first admitted to the hospital with a diagnosis of TSCI according to the International Classification of Diseases (10th revision) criteria. Age-adjusted incidence was calculated using direct standardization using the 2005 South Korean population or the 2000 US population as the standard population. The annual percentage changes (APC) of TSCI incidence were calculated. The Cochrane–Armitage trend test was performed according to the injured body region. Results In the NHIS database, age-adjusted TSCI incidence using the Korean standard population increased significantly from 2009 to 2018 (from 33.73 per million in 2009 to 38.14 per million in 2018, APC = 1.2%, P = 0.014). Contrarily, age-adjusted incidence in the AUI database significantly decreased from 13.88 per million in 2014 to 11.57 per million in 2018 (APC = – 5.1%, P = 0.009). In the IACI database, the age-adjusted incidence showed no significant difference, while crude incidence showed a significant increase (from 22.02 per million in 2014 to 28.92 per million in 2018, APC = 6.1%, P = 0.038). According to the age group, all the three databases showed high incidences of TSCI in those in their 60s and 70s or older. Among those in their 70s or older, the incidence of TSCI increased dramatically in the NHIS and IACI databases, while no significant trend was found in AUI database. In 2018, the number of TSCI patients was the highest among those over 70 years of age in the NHIS, whereas among those in their 50s were the highest in both AUI and IACI. The proportion of patients with cervical spinal cord injury was the most common in all these databases. Conclusions The differences in trends in the incidence of TSCI may be due to the different etiologies and different characteristics of subjects depending on insurance type. These results imply the need for tailored medical strategies for the different injury mechanisms represented by three national insurance services in South Korea.

This study aimed to estimate the trend of traumatic brain injuries (TBIs) and TBI-related medical usage in Korea. Patients first diagnosed with disease codes of TBIs were included. We calculated the crude incidence and age-adjusted incidence, as well as medical cost, length of stay (LOS), clinic visits, and the number of specialized rehabilitation therapy for 1 year. Patients first diagnosed as TBI was higher in national health insurance (NH-I) than in automobile insurance (AUTO-I). In contrast with the gradual decrease of the crude incidence, total medical costs both in NH-I and AUTO-I were generally and steadily increased. For oriental medicine, total medical costs dramatically increased in both inpatient and outpatient. LOS, clinic visits, and the number of specialized rehabilitation therapy were higher in AUTO-I than in NH-I. The most frequent age groups in NH-I were the young (0–9) and old (70 or over), whereas in AUTO-I, the working age group was prominent. Our results show differences in the incidence of TBI and medical usage between NH-I and AUTO-I, which could be associated with the policy for strengthening health insurance coverage, automobile-related regulations to prevent accidents and injuries, as well as rapid changes in the structure of the population in Korea.

Acquired brain injury (ABI) is a leading cause of serious long-term disability resulting in substantial economic costs for post-ABI care. This study was conducted to estimate the socioeconomic burden of persons with ABI in Korea. We used a prevalence-based approach and societal perspective to estimate the direct medical, non-medical costs and indirect costs of ABI, including stroke, traumatic brain injury (TBI), and non-traumatic ABI (anoxia, brain tumor, encephalitis, meningitis, hydrocephalus, and other brain disorders) from 2015 to 2017. The study population included patients with ABI over 20 years of age and analyzed according to insurance types encompassing National Health Insurance and automobile insurance. The socioeconomic burden of ABI was 4.67, 5.18, and 5.73 trillion KRW (approximately 4,162, 4,612, and 5,106 million USD) from 2015 to 2017 and around 0.3% of Korea's GDP annually. Estimating by disease, the socioeconomic cost was 72.4% for stroke, 18.6% for TBI, and 9.0% for non-traumatic ABI. Calculated by cost component, medical costs and non-medical costs showed a slight increase every year. Through this study, establishment of rehabilitation systems maximizing the health and quality of life for injured persons remain the key public health strategy for ABI to reduce socioeconomic burden and financial policies to support patients should be needed.