Association between private health insurance and medical use by linking subjective health and chronic diseases

This empirical study identifies the negative aspects of private health insurance (PHI) by analyzing the association between subjective health conditions, 2 weeks of outpatient care, chronic diseases, and hospitalizations for 1 year. We used frequency analysis, χ2 testing, an analysis of variance, and logistic and multiple logistic regression models to analyze the association between PHI and subjective health conditions, outpatient care, chronic disease status, and hospitalization. The PHI group had good subjective health but had more outpatient care for 2 weeks. There were few chronic diseases in the private insurance group, and there was no significant difference in hospitalizations for 1 year. Hospitalization may occur when essential medical care is required, regardless of health insurance type. This study confirmed that as the PHI lowers the burden of personal medical expenses, the PHI can lead to an increase in the medical resource expenditures on the outpatient medical service and higher public health costs. The government should work to redefine the role of private and national health insurance. Also, the effectiveness of PHI should be reevaluated so that it does not lead to indiscriminate use of medical services by minimizing the burden of private insurance.

Health Disparities among Wage Workers Driven by Employment Instability in the Republic of Korea

Even though labor market flexibility continues to be a source of grave concern in terms of employment instability, as evidenced by temporary employment, only a few longitudinal studies have examined the effects of employment instability on the health status of wage workers. Against this backdrop, this study assesses the manner in which changes in employment type affect the health status of wage workers. The data originate from the Korean Labor and Income Panel Study's health-related surveys for the first through fourth years (n = 1,789; 1998 to 2001). This study estimates potential damage to self-rated health through the application of a generalized estimating equation, according to specific levels of employment instability. While controlling for age, socioeconomic position, marital status, health behavior, and access to health care, the study analysis confirms that changes in employment type exert significant and adverse effects on health status for a given year (OR = 1.47; 95% CI 1.10–1.96), to an extent comparable to the marked effects of smoking on human health (OR = 1.47; 95% CI 1.05–2.04). Given the global prevalence of labor flexibility, policy interventions must be implemented if employment instability triggers broad discrepancies not only in social standing, wage, and welfare benefits, but also in health status.

Effect of private health insurance on health care utilization in a universal public insurance system: a case of South Korea

This study examined the effect of private health insurance (PHI) on health care utilization in South Korea using a nationally representative sample of 9512 adults participating in Korea Health Panel Survey (KHPS). We compared the health care utilization and subsequent expenditure according to whether or not and how many PHIs are purchased, controlling for the endogeneity of insurance purchase by propensity score matching method and Heckman-type treatment effect model. The results of this study show that the probability of any health care utilization, both outpatient care and inpatient care, is higher for the people who have PHI. For those who utilize health care, PHI has a positive impact on outpatient expenditure, but not on the number of outpatient visits. The effect of PHI on the number of inpatient days and expenditure is not statistically significant among the users of inpatient care. These results imply a need for policy options to mitigate the moral hazard effect of PHI in the outpatient care sector.

Common statistical and research design problems in manuscripts submitted to high-impact psychiatry journals: what editors and reviewers want authors to know

OBJECTIVE

Journal editors and statistical reviewers are often in the difficult position of catching serious problems in submitted manuscripts after the research is conducted and data have been analyzed. We sought to learn from editors and reviewers of major psychiatry journals what common statistical and design problems they most often find in submitted manuscripts and what they wished to communicate to authors regarding these issues. Our primary goal was to facilitate communication between journal editors/reviewers and researchers/authors and thereby improve the scientific and statistical quality of research and submitted manuscripts.

METHOD

Editors and statistical reviewers of 54 high-impact psychiatry journals were surveyed to learn what statistical or design problems they encounter most often in submitted manuscripts. Respondents completed the survey online. The authors analyzed survey text responses using content analysis procedures to identify major themes related to commonly encountered statistical or research design problems.

RESULTS

Editors and reviewers (n=15) who handle manuscripts from 39 different high-impact psychiatry journals responded to the survey. The most commonly cited problems regarded failure to map statistical models onto research questions, improper handling of missing data, not controlling for multiple comparisons, not understanding the difference between equivalence and difference trials, and poor controls in quasi-experimental designs.

CONCLUSIONS

The scientific quality of psychiatry research and submitted reports could be greatly improved if researchers became sensitive to, or sought consultation on frequently encountered methodological and analytic issues.