The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization

Park

Yoon

et al. 2019

BMC Health Serv Res

Self Cite

Background: Ambulatory care sensitive conditions (ACSC) hospitalization is a widely accepted measure of the access to primary care. However, given its discretionary characteristics, the ACSC hospitalization can be a measure reflecting the influence of hospital bed supply. In Korea, where the quality of primary care and oversupply of hospital beds are coexistent concerns, ACSC hospitalization can be used to examine the impact of both factors. This study was performed to investigate the ACSC hospitalization rate as a measure of the hospital bed supply as well as access to primary care. Methods: Data were obtained from the National Health Insurance Database for 2015. We calculated the age-sex standardized hospitalization rates for ACSC in the total population and crude rates of ACSC hospitalization for three different age groups in 252 districts in Korea. We calculated the variation statistics of ACSC hospitalization rates, and we estimated a linear regression model to investigate the factors for ACSC hospitalization. Results: There was a very high geographic variation in ACSC hospitalization rates. Higher density of primary care physicians was associated with a decreased ACSC hospitalization rate while a higher density of hospital beds in small to medium sized hospitals was associated with an increased rate. The deprivation index score had a strongly positive association with the ACSC hospitalization rates. Conclusion: ACSC hospitalization, while being a negative index of primary care access, can also be a measure indicating the impact of the hospital bed supply, and it is still a valid measure of the disparity of health care, the original motivation for this topic.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hospitalizations for ambulatory care sensitive conditions as an indicator of access to primary care and excess of bed supply

Park

Yoon

et al. 2019

BMC Health Serv Res

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“…We examined average healthcare use and costs related LLCs in the last year of life for each patient in terms of the number of hospitalizations, inpatient days, OPD visits, and ED visits. In order to identify the geographic distribution of deaths and any imbalances in healthcare use regarding LLCs between 17 administrative districts, relevance indices (RIs) were calculated by dividing the number of deceased patients with LLCs who used hospitals located in the same geographic region as their residence by the total number of deceased residents with LLCs in that area 18,19 . RI was analysed based on the sum of data from 2013 to 2015, considering the small number of deceased patients with LLCs.…”

Section: Variablesmentioning

confidence: 99%

Healthcare utilization among children and young people with life-limiting conditions: Exploring palliative care needs using National Health Insurance claims data

Song

et al. 2020

Sci Rep

Paediatric palliative care (PPC) is regarded as standard care for children and young people (CYP) with life-limiting conditions (LLCs). There is a lack of knowledge about the rate of CYP with LLCs, hampering the development of ppc. this retrospective study aimed to examine population-based statistics of South Korean CYP with LLCs and the pattern of healthcare use and costs in their last year of life, analysing the National Health Insurance Service claims database for the period 2013-2015. In 2015, the number of CYP (≤24 years old) living with LLCs was 133,177, with those who died accounting for 1,032. Prevalence of LLC and mortality rate per 100,000 were highest among under-1-age group (2,151.7 and 82.7, respectively). In the last year of life, 91.8% of deceased CYP with LLCs were hospitalized at least once and the average length of stay was 101.2 days (standard deviation = 104.1). Deceased CYP with cancer spent more on healthcare than non-cancer CYP (64,266 vs. 40,694 US dollar, p < 0.001). The average relevance index for CYP death related to LLCs was 55.9%. Our results provide baseline information on healthcare utilization and expenditure among CYP with LLCs, which is crucial data for designing evidence-based ppc policy and services. Paediatric palliative care (PPC) can be summarized as the active total care of the child's body, mind, and spirit, which also involves providing support to the family; it is suggested to start PPC at the time of diagnosis and continue to provide throughout the course of diseases 1. The practice of PPC started in England with the establishment of the first children's hospice, Helen House, in 1982. In recent decades, PPC has spread worldwide, taking on various forms in different countries. For instance, the United Kingdom has many residential hospice teams and facilities, while the United States has focused on hospital-based care. Recently, the World Health Assembly announced that the provision of PPC is an ethical responsibility of the health system, and that integrating palliative care into the public healthcare system is necessary to achieve the Sustainable Development Goal 3 regarding universal health coverage 2,3. South Korea achieved universal health coverage in 1989 4. The government has made efforts to improve healthcare for children, including the funding of 49 neonatal intensive care units and 7 specialized public medical centres for children 5. Advances in medical technology have contributed to improvements in a number of health indicators, such as the infant mortality rate (2.8/1,000 live births) and childhood cancer survival rate (83.6%) 6,7. However, PPC in Korea remains in its infancy. Over 1,000 children died from chronic complex conditions (CCCs) each year from 2005 to 2014 8. However, there were no hospitals or institutes meeting the standards for specialized PPC in South Korea until 2015 9. A multidisciplinary palliative care team for CYP was established at a tertiary

“…The hospitalization rates for asthma among age groups show a similar trend with the prevalence of asthma: highest among children, which is followed by the elderly. However, the regional difference in the hospitalization rates is far above the difference in the prevalence of asthma in Korea [25], and the variation in the hospitalization rates for asthma is unusually large compared with hospitalization rates of other common causes, which are also considered large compared to other countries [31,41]. This suggests that the decision for hospitalization for asthma in Korea is highly discretionary.…”

Section: Discussionmentioning

confidence: 99%

Regional Variation of Hospitalization Rates for Asthma in Korea: Association with Ambient Carbon Monoxide and Health Care Supply

Kang

Park

et al. 2020

IJERPH

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This study was performed to investigate the relationship between the hospitalization rate for asthma and the ambient carbon monoxide (CO) by examining regional variation of the hospitalization rates for asthma in Korea and its factors. The hospital inpatient claims for asthma were acquired from the National Health Insurance database in 2015. A multivariate linear regression was performed with the hospitalization rate for asthma as a dependent variable. The annual ambient concentration of CO showed a negative association with the hospitalization rates for asthma while that of sulfur dioxide showed a positive association. The number of primary care physicians showed a negative association with the hospitalization rates for asthma while the number of beds in hospitals with less than 300 beds showed a positive association. The negative association of the ambient concentration of CO with the hospitalization rates for asthma showed results upon further investigation.