The effects of long-term care insurance on the utilization of long-term care facility by inpatients in long-term care hospitals

2008년 우리나라에는 심신기능이 저하된 노인들에게 일상생활을 돕는 목적으로 노인장기요양보험이 도입되었다. 본 연구에서는 노인장기요양보험 도입 이후, 비효율적 의료자원 사용이라고 인식되었던 사회적 입원이 장기요양서비스 이용으로 대체되었는지 알아보기 위해, 노인장기요양보험 도입이 요양병원 내 입원환자의 장기요양시설 이용에 미친 영향을 파악하고자 하였다. 연구 결과, 정책수혜군의 장기요양시설 이용확률이 비교군보다 19.9% 더 높은 것으로 나타났다. 한편, 요양병원에 적용되는 재원일수에 따른 입원료 수가 감산제의 효과를 살펴본 결과, 입원료 5% 감산은 정책수혜군의 장기요양시설 이용에 미치는 영향은 없었던 반면 10% 감산은 장기요양시설 이용을 양의 방향으로 조절하는 것으로 나타났다. 결론적으로, 장기입원을 방지하고자 시행되고 있는 입원일수에 따른 입원료 수가 감산제의 효과가 제한적이므로 실효성이 있는 수준까지 감산 수준을 높이는 것을 제안한다. The public Long-term Care Insurance (LTCI) was introduced in July 2008. The main purpose of LTCI is to contribute to healthy aging of older people by providing timely and appropriate care services. Furthermore, it is expected to improve the distributional efficiency by reducing older peoples social admissions, which is considered medically unnecessary, due to social reasons such as an absence of the in-home caregiver. This study aimed to evaluate the effects of the LTCI introduction on utilization of long-term care facility (LTCF) by inpatients in long-term care hospitals (LTCH). In particular, whether the medical fee reduction, which is the penalty for extended hospital stays, has affected the LTCF uses by the LTCH patients was evaluated. The results showed that LTCF uses of the treatment group was 19.9% higher than that of the comparison group. In order to estimate the effect of the medical fee reduction policy, an interaction term between the policy treatment and medical fee reduction was introduced in the model. Study results indicated that the 5% reduction of the medical fee did not affect the use of LTCF of the treatment group while while a 10% reduction increased the LTCF utilization. In conclusion, in order to improve the care continuity between medical services and long-term care and to reduce hospitalization with long-term stay, it is necessary to reform the medical fee reduction policy as penalty for long-term stay in long-term care hospital.N

Improving Priority-setting Procedures for NHI benefit package

In health care, the process of resource allocation becomes a controversial process of rationing, as scarce resources are allocated between the numerous health care interventions. Especially for the last few years, decisions to define and expand the benefit package of National Health Insurance have always become the object of fierce criticism. It is partly because we have not reached a collective agreement as to what the most important criteria for spending priorities are. This paper considers the procedures and the principles which could be used to determine rationing in health care, and emphasizes the need to have explicit principles which determine patient access to care and to have an evidence base to inform rationing decisions. Also, the need to set up a public committee is suggested to take rationing decisions on behalf of government and NHS and to present them as evidence-based decisions.2

Surgery-first orthognathic approach for the correction of facial asymmetry

We aimed to compare the reliability of the surgery-first approach and the traditional orthodontic-first approach for the correction of facial asymmetry based on the new classification of facial asymmetry. Patients with facial asymmetry who underwent orthognathic surgery between January 2016 and January 2019 were included. Cephalometric changes and relapse ratios were analyzed 12 months before and after surgery. Patients were divided into horizontal and vertical asymmetry groups based on the asymmetry vector, and subgroup analysis was conducted. The surgery-first approach without presurgical orthodontic treatment and the orthodontic-first approach showed a similar degree of asymmetry correction and skeletal stability. The relapse ratios of the maxilla height in the surgery-first and orthodontic-first groups were 0.25 +/- 0.21 and 0.27 +/- 0.25, respectively (p = 0.63), the relapse ratios of the maxilla width were 0.31 +/- 0.32 and 0.21 +/- 0.2, respectively (p = 0.14), the mandibular height relapse ratios were 0.34 +/- 0.58 and 0.29 +/- 0.36, respectively (p = 0.69), and the mandibular width relapse ratios were 0.12 +/- 0.22 and 0.26 +/- 0.31, respectively (p = 0.058). The treatment period of the surgery-first group (18.5 +/- 5.3 months) was significantly shorter than that of the orthodontic-first group (22.9 +/- 7.5 months, p = 0.024). Among the surgery-first group, patients with vertical asymmetry (15.0 +/- 3.2 months) had a shorter treatment than those with horizontal asymmetry (21.6 = 6.8 months, p = 0.006). Although contesting traditional standards is always challenging, the surgery-first orthognathic approach may lead to a new era in traditional orthognathic approaches. This new classification of facial asymmetry could be useful and practical when treating patients with facial asymmetry regardless of the etiology. (C) 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved

Anterior Nasal Spine Relocation With Cleft Orthognathic Surgery

Background: In unilateral cleft nasal deformity, the skeletal, and cartilaginous framework of nose is deformed. The anterior nasal spine (ANS) is usually displaced to the non-cleft-side. In cleft orthognathic surgery, ANS relocation can help correct the deviated ANS and nasal septum and might lead to an improved esthetic and functional outcome. Methods: Patients with unilateral cleft lip who underwent two-jaw orthognathic surgery between July 2016 and July 2020 were reviewed retrospectively. During conventional two-jaw orthognathic surgery, the ANS was separated from the maxilla. The separated ANS with the attached septum was fixed on the maxillary midline by wiring. Computed tomography scan was used to measure the septal deviation angle and septal deviation from the midline. Results: The septal deviation from the maxillary midline decreased following surgery (preoperative versus postoperative: 4.6 +/- 1.0 mm versus 3.2 +/- 1.2 mm; P = 0.016). The coronal septal deviation angle was widened after ANS relocation, although the transverse septal deviation angle remained unchanged (coronal septal deviation angle, preoperative versus postoperative: 146.7 +/- 12.6 versus 159.8 +/- 7.6; P = 0.01; transverse septal deviation angle, preoperative versus postoperative: 156.5 +/- 11.7 versus 162.8 +/- 7.7; P = 0.128). Conclusions: This study suggests that simultaneous ANS relocation with orthognathic surgery is a viable option for cleft-related deformities, considering the resultant caudal septum straightening and stable structural support observed in the long-term