ObjectivesThis study investigated the factors influencing unmet healthcare needs of people during the early stage of the COVID-19 pandemic in Seoul, South Korea. The findings help to identify people who have difficulty accessing healthcare services during a pandemic situation.DesignWe conducted a cross-sectional study using a proportionate quota sampling method according to five major districts, sex and age, using an online survey. We analysed the key characteristics of influencing factors of unmet healthcare needs based on the Andersen behavioural model of healthcare utilisation: predisposing factors (eg, sex, age), need factors (eg, health status, illness) and enabling factors (eg, income, efficacy belief).SettingThe questionnaire was sent via email and mobile text messages from the end of April to the beginning of May 2020 during the first wave of the COVID-19 pandemic.ParticipantsA sample of 813 respondents was used, and the respondent information was anonymised in the analysis process.ResultsFor the predisposing factors, sex, age, education level and occupational cluster were associated with unmet needs for healthcare. Chronic diseases and mental health were the influencing factors as an enabling factor that exerted an influence on the unmet need for healthcare in South Korea. Women, younger persons, those with lower education and persons with white-collar jobs were more likely to experience unmet healthcare needs. In addition, the more chronic diseases people had, the more COVID-19 negatively affected them mentally; and the more people felt fear of COVID-19, the higher chances they experienced unmet healthcare needs.ConclusionGovernment and policymakers are guided to draw out measures such as health communication and telemedicine to reduce the unmet healthcare needs during the pandemic and to recognise the different influencing factors.

Obesity is a global pandemic that brings about a myriad of health consequences. In the past, policies for combating obesity mainly focused on improving individual health and behavior, but nowadays some policies have changed and now concentrate on improving the built environment believing this can improve health through positive changes to health-related behaviors. We examined whether both individual and environmental factors were associated with body mass index in Seoul, the capital city of South Korea. Data from the 2011 and 2013 Community Health Surveys were used (n = 20,147 men and 25,300 women). We staged multilevel logistic regression models to estimate the effect of individual and environmental factors on obesity. Among individual covariates, high-risk drinking, the time spent watching TV and surfing the Internet, high salt intake, stress, and the negative recognition of health were significantly associated with obesity. When controlling individual covariates, the number of sports facilities, number of fried chicken stores, and food insecurity level were statistically associated with probability of obesity. Therefore, this study emphasizes that it is important not only to improve the health behavior of the individual, but also to improve the urban environment in order to reduce the obesity rates of city dwellers.

The Medical Aid program is government’s medical benefit program to secure the minimum livelihood and medical services for low-income Korean households. In Seoul, the number of Medical Aid beneficiaries has grown, driving an increases in the length of stay (LOS) and healthcare cost. Until now, studies have focused on quantity indicators, such as LOS, but only a few studies have been conducted on the service quality. We investigated both LOS and the preventable hospitalization (PH) rate as proxy indicators for the quantity and quality of services provided to Medical Aid beneficiaries in Seoul. To understand the program’s impact, we extracted appropriate data of Medical Aid beneficiaries and data of the lower 20% of National Health Insurance (NHI) enrollees, performed Propensity Score Matching (PSM), and controlled the variables related to disease severity. The differences between Medical Aid beneficiaries and NHI enrollees were estimated using multilevel analysis. The LOS of Medical Aid beneficiaries was longer, and the preventable hospitalization (PH) rate was higher than that of NHI enrollees. It implies that these beneficiaries did not receive timely and adequate healthcare services, despite their high rate of service utilization. Thus, indicators such as patient’s visits and screening related to PHs should be included in management policies to improve primary care.

Mental illness has been increasing globally and its global burden of disease has reached a significant level, and urban dwellers have more chances of having worse mental health status due to high population density, isolated social networks. In Korea's medical security system, Medical Aid (MA) program and National Health Insurance (NHI), patients covered by MA pay much smaller out-of-pocket payments for outpatient services because of exempt from hospitalization fees. However, as a result of focusing on improving access to medical services for the urban poor due to lower out-of-pocket payment, their healthcare costs have greatly increased, while their health management has thus far been inadequate. In light of the background, this study investigated the differences in patterns of medical utilization among affective disordered patients covered by the MA program and the NHI system respectively. Data used for this study were extracted from customized health information data from the National Health Insurance Service (NHIS). The data source used in this study, customized claims data from the NHIS, is census data, which strengthens the representativeness and reliability of the study results. A total of 6754 inpatients (MA: 3327 and NHI 20%: 3327) diagnosed with the affective disorder were retrieved by Propensity Scores Matching (PSM). The length of stay of MA beneficiaries was found to be longer than that of NHI enrollees. However, the rate of hospital emergency room visits by NHI enrollees was higher than that of MA beneficiaries. Overall, community-based interventions are required to prevent and treat mental health by providing primary medical care in the community, and linking with mental health centers. Such policies will ultimately improve the financial sustainability of medical security systems.