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To improve the low coverage rate of the National Health Insurance (NHI), South Korea implemented the NHI coverage expansion plan in 2017 to cover medically essential non-covered services and reduce copayment rates. This study aimed to estimate the effects of the 2017 NHI coverage expansion on amenable mortality and its disparities between areas in South Korea under a controlled interrupted time-series design using Bayesian structural time-series models. Age-standardized amenable mortality rates and rate differences (RDs) and rate ratios (RRs) between areas for amenable mortality were calculated monthly between July 2012 and December 2021 and used as the response series. The non-equivalent control series were monthly non-avoidable mortality rates and their regional disparities. After the coverage expansion, amenable mortality rates decreased for both males (−8.8%, 95% credible interval [CrI] −13.4% to −3.9%) and females (−8.3%, 95% CrI −13.4% to −2.4%), with the largest decline in the non-Seoul-Capital metropolitan area (−11.6%, 95% CrI −16.5% to −6.3%) rather than the Seoul Capital Area (−7.5%, 95% CrI −11.9% to −2.5%) and a non-significant reduction in the non-Seoul-Capital non-metropolitan area in females. RDs and RRs between areas for amenable mortality decreased non-significantly (−16.2%, 95% CrI −31.3% to 2.6% for RD and −1.2%, 95% CrI −3.7% to 1.5% for RR), except for a significant decrease in RD in males (−21.8%, 95% CrI −38.0% to −1.5%), and decreased less in females than in males. The coverage expansion was generally effective in reducing amenable mortality rates by area, but had limited effects in closing amenable mortality disparities between areas, favoring males and the non-Seoul-Capital metropolitan area. These results implied that additional measures are necessary to improve access to quality health care for females and underserved areas to enhance the effectiveness of the coverage expansion. • South Korea expanded the coverage of the National Health Insurance in 2017. • The coverage expansion generally reduced amenable mortality rates by area. • But, it had limited effects in closing amenable mortality disparities between areas. • The coverage expansion seemed to benefit more males and metropolitan area. • Enhancing access to quality care for females and underserved areas is needed. [ABSTRACT FROM AUTHOR]

Abstract Background Previous epidemiologic studies of the natural course of urticaria mainly focused on chronic spontaneous urticaria and were conducted at hospitals. The natural course of new-onset urticaria in the general population is unknown. Methods Patients with new-onset urticaria were identified from the National Health Insurance Service–National Sample Cohort data. Patients who had at least one visit for urticaria in 2002 and 2003 were excluded and the study cohort consisted of 1,027,620 subjects with no history of urticaria. We analyzed cumulative incidences of urticaria, chronic urticaria, and chronic urticaria remission using the life table estimation method from 2004 to 2013. Their association with related factors was analyzed using the Cox proportional hazards analysis. Results From 2004 to 2013, a total of 49,129 patients with new-onset urticaria were identified. The 10-year cumulative incidence rate of urticaria for the general population was 4.9% and that of chronic urticaria among patients with new-onset urticaria was 7.8%. Remission rates of chronic urticaria were 52.6% at 1 year and 88.9% at 5 years. Age, sex, residential area, and autoimmune thyroid disease were significantly associated with urticaria or chronic urticaria, but not with chronic urticaria remission, after adjusting for covariates. Female individuals were more likely to have new-onset urticaria but less likely to develop chronic urticaria compared with male individuals. Conclusions During the 10-year follow-up period, only a small proportion of patients with new-onset urticaria developed chronic urticaria. Remission was achieved in the majority of patients with chronic urticaria regardless of demographic characteristics or accompanying thyroid disease. [ABSTRACT FROM AUTHOR]

This study aimed to identify the factors influencing South Korean voters’ attitudes towards increasing public expenditure on health and to identify whether the issue of healthcare expenditure influenced candidate choice in the 2012 Korean presidential election. The study used the data from a survey conducted by the Institute of Korean Politics at Seoul National University immediately following the 2012 presidential election. The survey was completed by a nationwide sample of 1,200 people aged 19 or over using a face-to-face interview method and proportional quota sampling based on sex, age, and region. About 44.3% of respondents had a positive attitude toward increasing public health expenditure. There was no significant difference by the candidate they supported (conservative Park Geun-hye or liberal Moon Jae-in). In particular, even 44.9% of conservative supporters agreed with more spending. Politically neutral respondents (OR = 1.76, 90% CI 1.22–2.54) and strong conservative party supporters (OR = 1.53, 90% CI 1.05–2.25) were more likely to support public health expenditure increase compared to strong liberal party supporters. Also, respondents who believed that the economic gap in the country was widening were 1.91 times more likely to support an increase in public health expenditures. However, the issue of health expenditure had no influence on voters’ choice of presidential candidates, and in particular no negative effect of choice of the ruling (conservative) party’s candidate. Our results should be interpreted with care; one possible reason for this lack of effect might be that constituents voted along partisan lines regardless of their attitude to the welfare issue; another possible explanation might be the success of the “left click strategy” of the conservative party. That is, the conservatives did not reject economic democratization or social welfare expansion. Further research should be done to explain why attitudes to health spending did not directly affect choice of candidate. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify private clinics that have a potential to perform the role of primary care providers (PCPs) in a primary care setting in Korea where private specialists are dominant. Methods: The 2013 National Patient Sample claim data of Health Insurance Review and Assessment Service in Korea was used. Two-step cluster analysis was performed using characteristics of private clinics, and patient and utilization characteristics of 27,797 private clinics. External validation of clusters was performed by assessing the association among clusters and outcomes of care provided by private clinics. Stability of clusters was cross-validated using discriminant analysis. Results: The result classified more than a half of private clinics into a potential PCP cluster. These were private clinics with specialties considered to be those of primary care physicians and were more likely to be located in non-metropolitan areas than specialized PCPs were. Compared to specialized PCPs, they had a higher percentage of pediatric and geriatric patients, patients with greater disease severity, a higher percentage of patients with complex comorbidities or with simple or minor disease groups, a higher number of patients and visits, and the same or higher quality of primary care. The most important factor in explaining variations between PCP clusters was the number of simple or minor disease groups per patient. Conclusion: This study identified potential PCPs and suggested the identifying criteria for PCPs. It will provide useful information for formulation of a primary care strengthening policy to policy makers in Korea as well as other countries with similar specialist-dominant primary care settings. [ABSTRACT FROM AUTHOR]

• The effectiveness of Korea's new stricter drunk-driving laws was assessed. • The laws reduced alcohol-related road traffic injury, minor injury, and crash rates. • The laws had no impact on alcohol-related road traffic death and severe injury rates. • Additional strategies are needed to reduce alcohol-related road traffic outcomes. In December 2018, new drunk-driving laws were enacted in Korea to impose stricter penalties and standards for driving under the influence of alcohol. This study aimed to estimate the effects of stricter drunk-driving laws on alcohol-related road traffic death, injury, and crash rates in Korea. Using police-reported traffic accident data and registered vehicle data from 2013 to 2020, monthly road traffic outcome rates were calculated: the response series involved alcohol-related rates and the non-equivalent control series involved total and non-alcohol-related rates. Based on a controlled interrupted time-series design using Bayesian structural time-series models, effects of the laws on alcohol-related road traffic outcome rates were evaluated. After implementation of these laws, the alcohol-related road traffic crash rate decreased by 14.3% (95% credible interval [CrI] −26.8% to −1.9%), alcohol-related road traffic injury rate by 17.6% (95% CrI −31.6% to −3.8%), and alcohol-related minor road traffic injury rate by 20.2% (95% CrI –32.4% to −7.7%). Alcohol-related road traffic death and severe injury rates also decreased more than the declining trends in the pre-period, but reduced non-significantly by 15.0% (95% CrI −47.2% to 17.3%) and 9.9% (95% CrI –33.9% to 14.5%), respectively. The mixed effectiveness of Korea's new drunk-driving laws on alcohol-related road traffic outcomes suggests that additional strategies are necessary to consistently and effectively reduce alcohol-related road traffic outcomes. More research is needed on ways to enhance the effectiveness of drunk-driving laws. [ABSTRACT FROM AUTHOR]

• Road traffic injury mortality in Korea has declined after peaking in the mid-1990s. • Road safety policies and the financial crisis might have affected this decline. • Educational expansion might reduce mortality risk through the cohort effect. • Mortality risk was high among the Korean Generation Y born in 1978–1983. • Policies to address the burden of road traffic injury require further improvement. Although mortality trends can be influenced by different ages, periods, and cohorts, few studies have demonstrated the age-period-cohort (APC) effect on road traffic injury (RTI) mortality. Moreover, APC effects in Korea have never been documented despite the high mortality rates from RTIs. This study aimed to describe the trends in mortality from RTIs and examine APC effects on RTI mortality in Korea. Using the national death certificate and census mid-year population estimates data during 1983–2017, trends in age-standardized mortality rates from RTIs were analyzed using Joinpoint regression. Intrinsic estimator regression models were used to estimate APC effects on RTI mortality. Consistent with the trend in period effects, RTI mortality increased sharply with the economic growth in the 1980s, decelerated after the implementation of road safety policies in the early 1990s, plummeted owing to the 1997–1998 financial crisis, and gradually decreased from the early 2000s. A J-shaped age effect indicated that the relative risk of road traffic death surged in people aged ≥65 years. Educational expansion from the mid-1950s turned an increasing birth cohort effect into a continuously decreasing trend after peaking around the 1938–1943 birth cohorts. The risk of road traffic death was relatively high among the Korean Generation Y, i.e., those born in 1978–1983. RTI mortality trends in Korea have been affected by diverse socioeconomic changes through cohort and period effects. Despite the recent favorable trend, RTI mortality remains high, especially among older people. Road safety policies to address the burden of RTIs require further improvement. [ABSTRACT FROM AUTHOR]

This study aimed to estimate age-period-cohort effects on avoidable mortality and quantify the impact of avoidable mortality changes on life expectancy (LE) at birth in the South Korean population aged 0–74 years. Using death certificate and resident population data from 2000 to 2017, trends in age-standardized avoidable mortality rates were analyzed with joinpoint regression. Intrinsic estimator regression analysis was conducted to estimate age-period-cohort effects on avoidable mortality. Arriaga's method was used to measure the contributions of avoidable causes to changes in LE gaps between adjacent three-year periods by age and avoidable cause of death groups. Avoidable mortality decreased annually by 4.6% between 2000 and 2017. There were strong age and cohort effects and a weak period effect on avoidable mortality. In the overall decreasing trend, avoidable mortality declined less in cohorts born after the 1950–1953 Korean War and economic recession in the 1970s, with further reductions in cohorts born after the 1987 democratic reform and 1997–1998 economic crisis. Avoidable mortality was reduced after implementation of major health policies, but the decrease stagnated during the 2008–2009 financial crisis. Avoidable mortality reduction resulted in LE gains of 3.1 years, which accounted for 80% of total LE gains. Contribution to LE gains by causes of death was the largest for cerebrovascular disease. Major social changes and health policies influenced the avoidable mortality trend through cohort and period effects. Health care and public health policies implemented since the 2000s might have contributed substantially to gains in LE. • There were strong cohort and small period effects on avoidable mortality rates. • Major social changes have affected declining trend of avoidable mortality in Korea. • Eighty percent of recent life expectancy gains were driven by avoidable causes. • Health policies implemented since the 2000s might have contributed to these gains. [ABSTRACT FROM AUTHOR]

Increase in travel time, beyond a critical point, to emergency care may lead to a residential disparity in the outcome of patients with acute conditions. However, few studies have evaluated the evidence of travel time benchmarks in view of the association between travel time and outcome. Thus, this study aimed to establish the optimal hospital access time (OHAT) for emergency care in South Korea. We used nationwide healthcare claims data collected by the National Health Insurance System database of South Korea. Claims data of 445,548 patients who had visited emergency centers between January 1, 2006 and December 31, 2014 were analyzed. Travel time, by vehicle from the residence of the patient, to the emergency center was calculated. Thirteen emergency care–sensitive conditions (ECSCs) were selected by a multidisciplinary expert panel. The 30-day mortality after discharge was set as the outcome measure of emergency care. A change-point analysis was performed to identify the threshold where the mortality of ECSCs changed significantly. The differences in risk-adjusted mortality between patients living outside of OHAT and those living inside OHAT were evaluated. Five ECSCs showed a significant threshold where the mortality changed according to their OHAT. These were intracranial injury, acute myocardial infarction, other acute ischemic heart disease, fracture of the femur, and sepsis. The calculated OHAT were 71–80 min, 31–40 min, 70–80 min, 41–50 min, and 61–70 min, respectively. Those who lived outside the OHAT had higher risks of death, even after adjustment (adjusted OR: 1.04–7.21; 95% CI: 1.03–26.34). In conclusion, the OHAT for emergency care with no significant increase in mortality is in the 31–80 min range. Optimal travel time to hospital should be established by optimal time for outcomes, and not by geographic time, to resolve the disparities in geographical accessibility to emergency care. [ABSTRACT FROM AUTHOR]