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Original Articles
The effect of public hospital closure on the death of long-term inpatients in Korea
Taeuk Kang, Minsung Sohn, Changwoo Shon
Epidemiol Health. 2024;46:e2024022.   Published online January 17, 2024
DOI: https://doi.org/10.4178/epih.e2024022
  • 1,252 View
  • 51 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study aimed to examine the changes in health outcomes and the patterns of medical institution utilization among patients with long-term stays in public hospitals following the closure of a public medical center. It also sought to present a proposal regarding the role of public hospitals in countries with healthcare systems predominantly driven by private entities, such as Korea.
METHODS
To assess the impact of a public healthcare institution closure on health outcomes in a specific region, we utilized nationally representative health insurance claims data. A retrospective cohort study was conducted for this analysis.
RESULTS
An analysis of the medical utilization patterns of patients after the closure of Jinju Medical Center showed that 67.4% of the total medical usage was redirected to long-term care hospitals. This figure is notably high in comparison to the 20% utilization rate of nursing hospitals observed among patients from other medical facilities. These results indicate that former patients of Jinju Medical Center may have experienced limitations in accessing necessary medical services beyond nursing care. After accounting for relevant mortality factors, the analysis showed that the mortality rate in closed public hospitals was 2.47 (95% confidence interval, 0.85 to 0.96) times higher than in private hospitals.
CONCLUSIONS
The closure of public medical institutions has resulted in unmet healthcare needs, and an observed association was observed with increased mortality rates. It is essential to define the role and objectives of public medical institutions, taking into account the distribution of healthcare resources and the conditions of the population.
Summary
Korean summary
본 연구는 사회보험제도를 기반으로 하고 있는 한국의 상황에서 지방의 공공의료기관 폐쇄가 환자들의 건강에 어떠한 영향을 미쳤는지를 확인하고자 국민건강보험 청구자료를 기반으로 후향적코호트 자료를 구축하여 분석을 시행하였다. 연구결과 장기 입원 환자의 67.4%가 장기요양병원을 의료를 이용하였고, 이는 비교집단의 장기요양 이용비율인 20% 수준보다 3배 가량 높은 수치로, 의료이용에 일부 제약이 발생하였을 가능성을 시사하는 것이다. 폐업 후 1년 이내 사망률을 비교한 결과, 인근지역 내 민간병원 환자와 비교하여 공공의료기관 입원환자의 사망확률은 2.67배였고, 의료급여 수급권자들의 사망확률은 고소득 5분위에 비해 2.24배 높은 것으로 나타났다.
Key Message
Even in Korea's healthcare system with high medical accessibility, adverse health impacts have been observed due to the closure of public healthcare institutions. Systematic policy development is necessary to evaluate essential medical service provision and allocate medical resources comprehensively.
Regional disparities in the availability of cancer clinical trials in Korea
Jieun Jang, Wonyoung Choi, Sung Hoon Sim, Sokbom Kang
Epidemiol Health. 2024;46:e2024006.   Published online December 11, 2023
DOI: https://doi.org/10.4178/epih.e2024006
  • 2,397 View
  • 58 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Unequal access to cancer clinical trials is an important issue, given the potential benefits of participation for cancer patients. We evaluated regional disparities in access to cancer clinical trials in Korea.
METHODS
From the Ministry of Food and Drug Safety database, we extracted 2,465 records of all cancer clinical trials approved between January 2012 and April 2023. To measure disparities in cancer clinical trial access, we calculated the ratio of clinical trials open to non-capital areas relative to those open to capital areas. We then analyzed temporal trends in this ratio, which we termed the trial geographical equity index (TGEI).
RESULTS
Disparities in access to cancer clinical trials, as indicated by the TGEI, did not significantly improve during the study period (regression coefficient, 0.002; p=0.59). However, for phase II/III trials sponsored by global pharmaceutical companies, the TGEI improved significantly (regression coefficient, 0.021; p<0.01). In contrast, the TGEI deteriorated for trials initiated by investigators or those testing domestically developed therapeutics (regression coefficient, -0.015; p=0.05). Furthermore, the increasing trend of TGEI for phase II/III trials sponsored by global companies began to reverse after 2019, coinciding with the outbreak of coronavirus disease 2019 (COVID-19).
CONCLUSIONS
Over the past decade, access to cancer clinical trials has improved in Korea, particularly for phase II/III trials evaluating therapeutics from global companies. However, this increase in accessibility has not extended to trials initiated by investigators or those assessing domestically developed therapeutics. Additionally, the impact of COVID-19 on disparities in clinical trial access should be closely monitored.
Summary
Korean summary
본 연구는 개시된 암 임상시험 수가 국내 수도권에 비해 비수도권에서 절대적으로 부족하고, 이러한 부족이 지난 10년간 개선되지 않았음을 보여줍니다. 다만, 글로벌 제약회사의 치료제를 검증하는 2상/3상 암 임상시험의 경우 임상시험 접근성에 대한 이러한 지역적 격차가 의미 있게 감소했으나 이러한 개선 또한 2019년 이후로는 정체되었을 수 있습니다. 상기 결과들은 임상시험 가용성의 형평성을 향상시키기 위해서는 국내 임상시험 개시 규모가 지역적 불균형을 이루고 있음에 대한 인식이 높아져야 하고, 비수도권 지역에서 임상시험 개시를 방해하는 장벽을 식별하는 데 추가적인 노력이 필요함을 강조합니다.
Key Message
The findings in this study indicate scarcity of cancer clinical trials in non-capital areas compared to that in capital areas of Korea, which has not improved over the past decade. However, this regional disparity in the access to clinical trials meaningfully decreased for phase II/III trials testing therapeutics from global pharmaceutical companies, though this progress may have stalled after 2019. This study highlights that increasing awareness of the regional imbalance in clinical trial access is vital and further efforts are needed to identify the barriers impeding the initiation of clinical trials in non-capital areas to improve the equity of availability.
Prevalence and factors associated with non-use of health services in the Peruvian population with COVID-19 symptomatology: a secondary analysis of the 2020 National Household Survey
Akram Hernández-Vásquez, Fabriccio J. Visconti-Lopez, Diego Azañedo
Epidemiol Health. 2021;43:e2021084.   Published online October 18, 2021
DOI: https://doi.org/10.4178/epih.e2021084
  • 7,747 View
  • 150 Download
  • 1 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The objective of this study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors in Peruvians with symptoms of coronavirus disease 2019 (COVID-19).
METHODS
A secondary analysis of the 2020 National Household Survey (ENAHO) was carried out. Participants over 18 years of age with any COVID-19 symptom (fever, cough, sensation of shortness of breath) in the last 4 weeks who did not visit health services were defined as exhibiting NUHS. Adjusted prevalence ratios (aPRs) were estimated to determine the factors associated with NUHS.
RESULTS
Data from 1,856 participants were analyzed; the prevalence of NUHS was 52.2% (95% confidence interval [CI], 48.0 to 56.5). Living in urban areas of the jungle (aPR, 1.61; 95% CI, 1.32 to 1.98; p<0.001) and rural areas of the jungle (aPR, 1.48; 95% CI, 1.15 to 1.90; p=0.002) was associated with a higher probability of NUHS than living in urban coastal areas. The factors associated with a lower probability of NUHS were being 50-59 years old (aPR, 0.72; 95% CI, 0.58 to 0.90) and 60 years and over (aPR, 0.74; 95% CI, 0.59 to 0.95), having a secondary educational level (aPR, 0.67; 95% CI, 0.48 to 0.93) or superior educational level (aPR, 0.67; 95% CI, 0.48 to 0.96), and having health insurance (aPR, 0.79; 95% CI, 0.68 to 0.92).
CONCLUSIONS
More than half of the participants with COVID-19 symptoms did not use health services, and NUHS was associated with the geographic and socio-demographic characteristics of the population. The formulation of health strategies and programs is required to increase the use of health services by people with COVID-19 symptoms.
Summary
Key Message
The objective of this study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors in Peruvians with symptoms of coronavirus disease 2019 (COVID-19) in 2020. In the study, more than half of the participants with COVID-19 symptoms did not use health services, and NUHS was associated with the geographic and socio-demographic characteristics of the population. The formulation of health strategies and programs is required to increase the use of health services by people with COVID-19 symptoms, in the country with the highest mortality rate by this disease.

Citations

Citations to this article as recorded by  
  • Staying in or out? COVID-19-induced healthcare utilization avoidance and associated socio-demographic factors in rural India
    Michael Safo Oduro, Prince Peprah, Anthony Kwame Morgan, Williams Agyemang-Duah
    BMC Public Health.2023;[Epub]     CrossRef
  • Chronic disease relapses: A cross-sectional study of the associated factors and socioeconomic inequalities during the COVID-19 pandemic in Peru
    Fabriccio J. Visconti-Lopez, Akram Hernández-Vásquez, Dustin M. Solorzano-Salazar, Diego Azañedo, Ramune Jacobsen
    PLOS ONE.2022; 17(9): e0274697.     CrossRef
  • COVID-19 and drivers of excess death rate in Peru: A longitudinal ecological study
    Kim N. Cajachagua-Torres, Hugo G. Quezada-Pinedo, Carlos A. Huayanay-Espinoza, Jordan A. Obeso-Manrique, Víctor A. Peña-Rodríguez, Elisa Vidal, Luis Huicho
    Heliyon.2022; 8(12): e11948.     CrossRef
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