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Kim, Pyo, Lee, Jeong, Park, Seo, Ock, and Yoon: Relevance Index Regional Variation by Each Disease and Its Essential Medical Field: A Retrospective Data Analysis From 2016-2020 in Korea
Original Article
Medicine General & Policy

Journal of Korean Medical Science 2023; 38(16): e130.

Published online: 14 April 2023

DOI: https://doi.org/10.3346/jkms.2023.38.e130

Relevance Index Regional Variation by Each Disease and Its Essential Medical Field: A Retrospective Data Analysis From 2016-2020 in Korea

Young-Eun Kim1, Jeehee Pyo2, Haneul Lee2, 3, HyeRan Jeong2, 3, Young-Kwon Park4, Jeong-Wook Seo5, Minsu Ock2, 3, 4, 6, Seok-Jun Yoon7

1Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea.

2Task Forces to Support Public Health and Medical Services in Ulsan Metropolitan City, Ulsan, Korea.

3Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

4Prevention and Management Center, Ulsan University Hospital, Ulsan, Korea.

5Public Health and Medical Services Team, Ulsan University Hospital, Ulsan, Korea.

6Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.

7Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.

Address for Correspondence: Minsu Ock, MD, PhD. Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 25 Daehakbyeongwon-ro, Dong-gu, Ulsan 44033, Republic of Korea. ohohoms@naver.com

Received 25 June 2022       Accepted 11 January 2023

© 2023 The Korean Academy of Medical Sciences.

The Korean Academy of Medical Sciences

https://creativecommons.org/licenses/by-nc/4.0/
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

To precisely build a healthcare delivery system at regional levels, local patients’ healthcare service utilization patterns must be examined. Hence, this study utilized trend analysis of the relevance index of each disease of each essential medical service field at the municipal and provincial levels.

Methods

This study analyzed customized databases released by the National Health Insurance Service from 2016–2020. Diseases defined in the Korean National Burden of Disease (KNBD) study were categorized into the following essential medical service fields: trauma care, cardiocerebrovascular, maternal and neonatal, mental health, infection, cancer, older adults’ care and rehabilitation, and others. Relevance index, the percentage of medical service utilization in a region by the residents of that region relative to their total medical service utilization, was examined by region (17 municipal and provincial regions) and disease area. The relevance index was determined based on the number of patients and the total out-of-pocket expenses.

Result

Eight of the 17 regions showed over a 90.0% relevance index in the infection area. In the cancer area, 14 regions (not including Seoul, Daegu, and Busan) had a relevance index lower than 75.0%. Throughout the analysis period (2016–2020), there were no significant variations in the relevance index. Diseases such as bone and connective tissue cancer (39.0%), neural tube defects (16.7%), and autism (57.1%) had low relevance index in the essential medical service fields. In all 17 regions, the relevance index of inpatients was lower than that of outpatients, and that for out-of-pocket expenses was lower than that based on the number of patients.

Conclusion

The relevance index of major diseases of each essential medical service field calculated in this study can provide good indicators for monitoring the level of an independent regional healthcare delivery system.

Graphical Abstract

jkms-38-e130-abf001.jpg

Keywords: Relevance Index, Essential Medical Service, Public Healthcare, National Burden of Disease

INTRODUCTION

Despite efforts to reduce the health inequalities among Korean regions, regional health inequalities still exist. For example, a comparison of the age-standardized mortality rates among the 17 municipal and provincial regions (hereafter “17 regions”) shows no significant changes over time in the disparities between the regions showing the highest and lowest mortality rates.1 Regarding the regional health inequalities for healthy life expectancy, differences between the regions showing the highest and lowest health-adjusted life expectancy and quality-adjusted life expectancy, which are widely used measures of healthy life expectancy,2 are 3.2 and 4.6 years, respectively.34 Another study found that the regional disparity in health-adjusted life expectancy increased from 4.9 years in 2008 to 5.7 years in 2008.5
Among many causes of regional health inequalities, one is the situation wherein residents in a region cannot receive the essential medical services when health needs arise.6 This requires not only the existence of medical institutions that can provide essential medical care, but also the need to consider the existence of medical institutions that can satisfy the preferences of local residents. Therefore, whether a local community has the infrastructure required for a good delivery of essential medical services, which is closely related to life and has a decisive influence on health-related quality of life, must be examined. The Korean government is recently attempting to position a healthcare delivery system in each region with the Public Healthcare Network Plan and Regional Healthcare Promotion Plan.78 As a part of such efforts, they began to designate and operate competent medical institutions (so-called “Accountable Care Hospital”) in 17 regional and 70 subregions across the country.9 Designated medical institutions provide high-quality medical services in the essential medical fields, including trauma care, cardiocerebrovascular, maternal and neonatal, mental health, infection, cancer, and older adults’ care and rehabilitation areas at the regional and local levels.
However, the most significant in a precise regional healthcare delivery system structure is examining how local patients use healthcare services, which is the relevance index status. The data on patients’ regional healthcare service utilization patterns provide a crucial evidential basis for assembling regional and local leading medical institutions’ concrete roles and building additional ones. In Republic of Korea (hereinafter Korea), studies on relevance index have been reported in some diseases or disease areas,101112 but they do not consider the trend analysis of relevance index of the diseases in the essential medical service fields. Park et al.13 attempted to analyze the relevance index trends, but it was limited to one region (Ulsan Metropolitan City).
To bridge this research gap, this study aimed to analyze the trends of relevance index by region and disease in each essential medical service field. Furthermore, this study intended to broaden the scope of relevance index analysis by classifying relevance index according to service utilization type (inpatient and outpatient) and unit (number of patients and total out-of-pocket expenses).

METHODS

Essential medical service fields and disease classification

The definitions for essential medical services are varied.14 The Public Health and Medical Services Act defines the term “public health and medical services” as “all activities of the State, local governments, and public and medical institutions to ensure all citizens equal access to medical services and to protect and promote their health.”15 This study is based on the definition and the disease classification system used in the Korean National Burden of Disease (KNBD) study,1617 which provides a basis for prioritizing interventions between diseases using an indicator of disability-adjusted life-years (DALYs). With reference to the disease classification system of the KNBD study, we divided the essential medical services into eight areas: trauma care, cardiocerebrovascular, maternal and neonatal, mental health, infection, cancer, older adults’ care and rehabilitation, and others. A total of 260 diseases defined as diagnostic codes17 in the diseases used in the KNBD study were re-classified into the eight essential medical service fields as in a previous study.13 A complete list of diseases and their classification into essential medical service fields are presented in the supplementary file (Supplementary Table 1).

Data source

This study used customized databases of the National Health Insurance for analysis.18 Considering the size of the analysis data, the analysis period is limited to 2016 to 2020. After classifying the datasets for annual inpatient and outpatient medical service utilization (claim) of each patient, those for medical or dental clinics and hospitals, and public health institutions were selected for analysis; those for oriental medical institutions were discarded. The data source used for relevance index analysis included the address, medical institution used, and the diagnostic code information for the disease definition of each patient.

Relevance index analysis

The relevance index refers to the percentage of residents’ medical service utilization in a region relative to their total medical service utilization.19 This suggests the residents’ preference for a specific region for their medical institutions and is often used as an indicator for the patient outflow (medical service utilization in other regions). For example, if a patient living in Ulsan Metropolitan City uses inpatient or outpatient care at an Ulsan-based medical institution, the case is added to the numerator, increasing the relevance index. In contrast, if that patient uses the facilities from a medical institution located in a different region, the case cannot be added to the numerator, decreasing the relevance index.19
RIij = (Amount of medical service utilization in medical institutions in j region by a patient living in i region)/(Total amount of medical service utilization by a patient living in i region)
This study divided the medical service area into 17 regions according to the 17 municipal and provincial regions. Relevance index analysis was performed based on two criteria: first, service utilization type (inpatient and outpatient) and second, unit (number of patients and total out-of-pocket expenses). However, due to the difficulty in defining the diseases in trauma care with the limited data source, the relevance index of the diseases in the trauma care area was not analyzed.
Descriptive analysis was performed to examine the relevance index by year (2016–2020), region, criteria, essential medical service field, and disease. The mean relevance index considering the number of patients or the total out-of-pocket expenses was summarized as the five-year weighted average relevance index. For example, the five-year weighted average relevance index based on the number of patients in a specific disease was calculated using the following formula.
Five-year weighted average relevance index = (2016A × 2016B) + (2017A × 2017B) + (2018A × 2018B) + (2019A × 2019B) + (2020A × 2020B)/(2016A + 2017A + 2018A + 2019A + 2020A)
A: Number of patients in a given year for a specific disease, B: relevance index in a given year for a specific disease
Data were processed using Microsoft Excel 2016 (Microsoft Corporation, Seattle, WA, USA), and Stata/SE13.1 (StataCorp, College Station, TX, USA) was used for descriptive analysis.

Ethics statement

This study received approval from the Institutional Review Board of the Ulsan University Hospital (2021-05-042). Informed consent was waived by the board.

RESULTS

Relevance index by essential medical service field

Fig. 1 compares the five-year weighted average of relevance index for each essential medical service field based on the number of outpatient and inpatient care cases at the regional level. Among the seven essential medical service fields, the infection area showed a generally high relevance index, with 8 out of the 17 regions resulting in over 90.0%. In contrast, the cancer area showed a generally low relevance index, with 14 regions (not including Seoul, Daegu, and Busan) resulting in a lower than 75.0% relevance index.
Fig. 1

Weighted average of relevance index by essential medical service fields in 2016–2020 (based on the number of patients: inpatient).

Gyeonggi, Gyeonggi-do; Gangwon, Gangwon-do; Chungbuk, Chungcheongbuk-do; Chungnam, Chungcheongnam-do; Jeonbuk, Jeollabuk-do; Jeonnam, Jeollanam-do; Gyeongbuk, Gyeongsangbuk-do; Gyeongnam, Gyeongsangnam-do; Jeju, Jeju-do
jkms-38-e130-g001

Trends in relevance index by the regional and national averages (2016–2020)

Table 1 shows the changes in the relevance index for each essential medical service field for the number of patients and hospitalization across the country (median of the 17 regions) and each of the 17 regions. Throughout the analysis period (2016–2020), no significant changes were observed in regional relevance. At a national level, variations in the relevance index ranged within 2%p between 2016 and 2020, except for the cardiocerebrovascular area. The area with the most significant decrease in relevance index was the maternal and neonatal area (from 79.1% in 2016 to 77.4% in 2020), and the area with the most significant increase was the cardiocerebrovascular area (from 76.0% in 2016 to 79.7% in 2020).
Table 1

Relevance index by each essential medical service field in 17 regions by year (based on the number of patients: inpatient)

jkms-38-e130-i001
Area Region 2016 2017 2018 2019 2020
Cardiocerebrovascular Seoul 84.9 86.2 86.2 86.9 87.2
Busan 89.4 88.9 89.0 89.1 89.7
Daegu 90.5 90.6 90.6 91.0 91.7
Incheon 75.4 77.7 78.2 79.0 79.7
Gwangju 89.3 89.1 89.5 89.3 89.9
Daejeon 88.6 88.7 88.5 89.1 88.3
Ulsan 83.7 84.7 83.7 84.5 86.1
Sejong 8.2 8.3 6.4 4.1 19.5
Gyeonggi-do 73.7 72.8 72.9 73.0 72.9
Gangwon-do 76.0 76.1 76.4 74.6 76.1
Chungcheongbuk-do 69.8 69.6 69.9 70.0 71.3
Chungcheongnam-do 54.8 55.6 54.6 53.6 53.6
Jeollabuk-do 82.0 81.6 81.4 82.0 83.1
Jeollanam-do 53.9 52.7 51.8 51.3 53.1
Gyeongsangbuk-do 61.0 61.5 61.2 60.3 61.0
Gyeongsangnam-do 71.3 72.5 72.5 72.5 73.2
Jeju-do 84.9 84.2 82.0 81.6 83.9
Total (median) 76.0 77.7 78.2 79.0 79.7
Maternal and neonatal Seoul 89.0 89.7 89.7 90.4 91.0
Busan 91.7 91.7 91.3 90.7 90.8
Daegu 94.5 94.3 94.2 94.4 94.1
Incheon 76.4 76.6 73.7 73.8 74.8
Gwangju 93.8 93.0 93.4 92.9 92.5
Daejeon 89.9 90.1 90.8 89.9 90.2
Ulsan 84.2 85.1 84.6 84.9 85.5
Sejong 21.0 21.1 25.3 34.5 43.4
Gyeonggi-do 78.9 78.3 78.1 77.2 77.4
Gangwon-do 79.1 78.9 78.2 76.9 76.6
Chungcheongbuk-do 75.1 74.5 73.5 71.1 72.3
Chungcheongnam-do 71.2 71.1 71.5 70.7 71.9
Jeollabuk-do 86.7 86.6 84.8 84.0 84.7
Jeollanam-do 61.1 60.8 58.7 59.1 58.9
Gyeongsangbuk-do 61.6 59.4 58.1 55.3 54.2
Gyeongsangnam-do 76.2 75.9 75.9 75.3 75.6
Jeju-do 90.1 89.8 87.8 88.1 87.6
Total (median) 79.1 78.9 78.2 77.2 77.4
Mental health Seoul 60.0 61.2 60.8 60.0 57.1
Busan 72.7 73.6 73.4 75.3 76.1
Daegu 80.7 80.0 81.5 82.6 82.5
Incheon 72.3 74.8 76.6 77.1 77.6
Gwangju 73.0 73.7 75.7 74.3 74.1
Daejeon 73.4 72.3 70.1 72.6 72.4
Ulsan 71.4 73.3 72.6 78.2 74.9
Sejong 14.2 10.1 10.1 8.0 12.2
Gyeonggi-do 76.2 76.0 75.8 76.0 75.8
Gangwon-do 75.8 77.6 76.6 76.5 75.8
Chungcheongbuk-do 74.6 75.3 76.8 77.6 73.9
Chungcheongnam-do 72.2 76.3 75.4 74.0 74.8
Jeollabuk-do 81.7 78.4 79.3 79.1 80.5
Jeollanam-do 68.3 69.1 69.2 69.1 69.6
Gyeongsangbuk-do 72.9 72.5 73.1 73.1 74.6
Gyeongsangnam-do 81.7 82.8 83.0 83.3 83.1
Jeju-do 76.7 78.3 77.0 78.1 80.9
Total (median) 73.0 74.8 75.7 76.0 74.9
Infection Seoul 86.5 85.8 85.6 85.8 83.8
Busan 93.2 92.7 92.7 92.8 91.3
Daegu 93.7 93.5 94.0 94.6 92.6
Incheon 86.0 86.1 85.8 86.6 86.0
Gwangju 95.1 95.4 95.4 95.5 94.7
Daejeon 92.7 92.3 93.2 94.1 92.6
Ulsan 93.1 93.2 93.2 93.3 92.2
Sejong 9.8 16.8 34.7 41.7 55.5
Gyeonggi-do 86.6 86.1 86.5 87.0 85.6
Gangwon-do 86.7 86.7 86.6 86.1 85.5
Chungcheongbuk-do 87.2 85.6 85.6 85.4 84.6
Chungcheongnam-do 79.0 78.4 78.8 78.2 77.3
Jeollabuk-do 91.9 91.7 92.2 92.4 92.4
Jeollanam-do 83.1 81.7 81.5 83.4 83.3
Gyeongsangbuk-do 79.8 78.7 79.0 78.1 77.7
Gyeongsangnam-do 91.5 91.4 91.8 92.2 91.9
Jeju-do 94.0 93.3 92.9 93.4 93.1
Total (median) 87.2 86.7 86.6 87.0 86.0
Cancer Seoul 89.7 89.8 89.8 90.3 90.3
Busan 79.3 79.1 78.5 78.1 79.4
Daegu 81.4 80.6 79.8 80.7 80.8
Incheon 65.7 67.2 66.4 65.4 65.4
Gwangju 55.4 54.1 54.3 54.8 55.3
Daejeon 73.0 72.0 71.4 70.9 70.8
Ulsan 71.3 70.1 70.6 69.5 71.5
Sejong 3.4 3.2 3.0 3.7 11.0
Gyeonggi-do 60.6 60.2 59.8 59.5 59.8
Gangwon-do 59.3 59.1 57.2 57.2 58.6
Chungcheongbuk-do 45.7 46.2 45.6 45.1 45.3
Chungcheongnam-do 43.3 43.6 44.2 43.6 43.9
Jeollabuk-do 67.7 68.2 67.0 67.5 69.0
Jeollanam-do 56.0 56.4 56.0 56.3 57.4
Gyeongsangbuk-do 31.3 31.5 31.0 30.2 29.9
Gyeongsangnam-do 55.0 56.0 55.5 55.2 56.6
Jeju-do 59.9 60.3 57.5 56.7 58.8
Total (median) 59.9 60.2 57.5 57.2 58.8
Older adults’ care and rehabilitation Seoul 86.8 86.8 86.9 87.4 87.2
Busan 90.9 89.9 89.7 89.9 91.1
Daegu 90.3 89.6 89.9 90.1 90.6
Incheon 80.8 81.3 81.4 80.9 79.8
Gwangju 94.0 94.4 94.2 93.7 93.9
Daejeon 88.4 87.6 87.6 88.2 88.3
Ulsan 82.7 82.7 83.0 82.9 83.1
Sejong 6.0 6.6 6.5 9.5 15.5
Gyeonggi-do 75.1 74.3 74.7 74.7 75.0
Gangwon-do 61.7 61.9 61.3 60.7 61.2
Chungcheongbuk-do 66.5 66.2 66.3 66.0 66.1
Chungcheongnam-do 50.3 52.1 52.2 52.4 54.5
Jeollabuk-do 80.3 80.2 79.2 78.6 79.7
Jeollanam-do 62.9 62.3 61.1 61.2 62.4
Gyeongsangbuk-do 52.2 52.1 52.2 51.2 51.2
Gyeongsangnam-do 73.6 74.7 74.6 75.2 75.8
Jeju-do 64.8 61.8 61.8 62.7 65.2
Total (median) 75.1 74.7 74.7 75.2 75.8
Others Seoul 87.7 88.2 88.4 88.8 89.0
Busan 90.7 90.4 90.3 90.5 90.8
Daegu 90.6 90.6 90.9 91.3 91.2
Incheon 80.3 80.6 79.8 79.4 78.5
Gwangju 89.5 89.8 89.9 90.0 89.8
Daejeon 88.6 88.4 88.2 88.3 87.5
Ulsan 85.8 85.7 85.5 85.7 85.8
Sejong 16.2 19.0 18.1 19.3 34.4
Gyeonggi-do 76.1 75.3 74.0 72.7 70.6
Gangwon-do 78.1 78.6 77.9 77.0 77.2
Chungcheongbuk-do 75.8 75.5 75.0 74.7 74.4
Chungcheongnam-do 68.9 68.4 68.0 67.7 66.8
Jeollabuk-do 85.9 86.4 85.8 85.5 85.6
Jeollanam-do 69.3 68.8 67.4 66.8 67.3
Gyeongsangbuk-do 68.5 68.1 67.1 65.8 65.8
Gyeongsangnam-do 80.1 79.9 79.5 79.1 78.6
Jeju-do 86.9 86.4 85.5 85.2 86.3
Total (median) 80.3 80.6 79.8 79.4 78.6
Units: %.

Trends in relevance index by disease

Table 2 presents the changes in the relevance index for 238 diseases during the analysis period (2016–2020). As of 2020, 31 out of the 234 confirmed occurrence of diseases showed a relevance index of 0.0%; the disease with the lowest relevance index in the cancer area was bone and connective tissue cancer (39.0%), followed by ovarian cancer (46.5%) and mouth cancer (49.0%). In the maternal and neonatal areas, congenital anomalies such as neural tube defects (16.7%), cleft lip and cleft palate (18.5%), and congenital heart anomalies (40.5%) showed low relevance index values. In contrast, the relevance index values of ischemic stroke and ischemic heart disease, specific diseases in the cardiocerebrovascular area, were as high as 80.1% and 78.8%, respectively. In the mental health field, apart from addiction-related diseases, bulimia nervosa (0.0%) and autism (57.1%) showed low relevance index values. The relevance index trends by disease for each of the 17 regions are shown in the appendix file (Supplementary Tables 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18).
Table 2

Trends in relevance index by disease related to essential medical service (based on the number of inpatients: median of 17 regions)

jkms-38-e130-i002
No. Diseases 2016 2017 2018 2019 2020
1 Tuberculosis 77.6 78.8 77.2 78.3 82.0
2 HIV disease resulting in mycobacterial infection 0.0 0.0 0.0 0.0 0.0
3 HIV disease resulting in other specified or unspecified diseases 55.6 56.6 58.6 68.4 71.9
4 Cholera 83.3 0.0 0.0 0.0 0.0
5 Other salmonella infections 90.5 89.8 91.8 87.3 89.8
6 Shigellosis 100.0 93.3 94.1 100.0 100.0
7 Enteropathogenic E coli infection 50.0 71.4 0.0 0.0 0.0
8 Enterotoxigenic E coli infection 0.0 0.0 50.0 87.5 25.0
9 Campylobacter enteritis 91.3 91.1 90.3 90.7 91.9
10 Amoebiasis 80.9 76.1 75.0 73.2 68.5
11 Cryptosporidiosis 0.0 0.0 0.0 100.0 0.0
12 Rotaviral enteritis 89.6 92.6 93.9 90.3 90.9
13 Intestinal infection 91.8 85.5 85.3 85.4 83.7
14 Other diarrheal diseases 88.4 88.9 87.9 89.0 89.2
15 Typhoid and paratyphoid fevers 88.9 88.9 72.7 100.0 100.0
16 Influenza 92.3 89.8 89.5 91.2 90.0
17 Pneumococcal pneumonia 83.3 82.8 83.3 83.9 80.7
18 H influenza type B pneumonia 83.3 80.0 88.7 90.0 88.0
19 Respiratory syncytial virus pneumonia 89.1 91.4 90.7 85.7 86.2
20 Other lower respiratory infections 88.4 87.6 87.0 86.9 85.8
21 Upper respiratory infections 88.3 88.7 89.4 90.0 89.3
22 Otitis media 80.0 81.6 81.0 79.5 76.2
23 Pneumococcal meningitis 50.0 0.0 0.0 0.0 0.0
24 H influenza type B meningitis 0.0 0.0 0.0 0.0 0.0
25 Meningococcal infection 0.0 0.0 0.0 0.0 0.0
26 Other meningitis 91.5 87.3 86.2 86.5 84.1
27 Encephalitis 68.7 65.0 65.6 65.2 60.6
28 Diphtheria 0.0 0.0 0.0 0.0 0.0
29 Whooping cough 100.0 86.7 95.7 96.9 90.0
30 Tetanus 62.5 63.3 100.0 80.4 90.0
31 Measles 85.7 75.0 83.3 86.2 0.0
32 Varicella 87.7 89.4 87.5 87.5 88.5
33 Malaria 50.0 50.0 82.9 50.0 85.1
34 Chagas disease 50.0 0.0 50.0 0.0 0.0
35 Leishmaniasis 0.0 0.0 0.0 0.0 0.0
36 African trypanosomiasis 50.0 50.0 0.0 0.0 0.0
37 Schistosomiasis 0.0 0.0 0.0 0.0 0.0
38 Cysticercosis 66.1 60.8 58.3 47.2 55.0
39 Echinococcosis 0.0 0.0 0.0 50.0 0.0
40 Lymphatic filariasis - - - - -
41 Onchocerciasis - - - - -
42 Trachoma 0.0 50.0 0.0 50.0 0.0
43 Dengue - - - - -
44 Yellow fever 0.0 100.0 0.0 0.0 0.0
45 Rabies 0.0 0.0 100.0 0.0 0.0
46 Ascariasis 0.0 100.0 0.0 0.0 0.0
47 Trichuriasis 100.0 0.0 0.0 0.0 0.0
48 Hookworm disease 0.0 100.0 0.0 50.0 0.0
49 Food-borne trematodiases 75.0 77.8 80.0 69.2 66.7
50 Tsutsugamushi fever 86.2 78.4 84.2 83.6 84.6
51 Typhus fever 85.6 87.9 66.7 78.3 83.3
52 Hantaan virus disease 90.0 86.5 85.7 75.3 94.1
53 Other neglected tropical diseases 66.3 70.0 69.2 75.8 73.3
54 Intestinal helminth 100.0 100.0 90.9 85.7 71.4
55 Maternal hemorrhage 83.2 83.4 80.7 79.8 81.6
56 Maternal sepsis 89.5 66.7 75.0 75.0 83.3
57 Hypertensive disorders of pregnancy 77.8 79.6 75.5 79.7 76.8
58 Obstructed labor 81.4 84.7 84.3 86.8 88.0
59 Abortion 83.8 80.1 81.1 78.0 83.5
60 Other maternal disorders 83.1 82.8 82.7 82.1 82.5
61 Preterm birth complications 71.0 75.9 73.5 71.8 71.4
62 Neonatal encephalopathy (birth asphyxia and birth trauma) 75.0 71.4 74.4 61.5 66.7
63 Sepsis and other infectious disorders of the newborn baby 79.2 84.8 78.2 77.8 78.4
64 Other neonatal disorders 78.5 76.6 78.4 80.3 75.2
65 Protein-energy malnutrition 56.7 79.0 86.9 83.3 80.0
66 Iodine deficiency 0.0 0.0 0.0 0.0 0.0
67 Vitamin A deficiency 50.0 66.7 50.0 85.7 71.4
68 Iron-deficiency anemia 84.3 83.7 84.7 83.7 84.5
69 Other nutritional deficiencies 77.8 77.4 76.6 81.7 80.9
70 Syphilis 78.1 76.7 82.2 76.7 87.5
71 Sexually transmitted chlamydial diseases 85.0 66.7 88.9 78.6 75.0
72 Gonococcal infection 75.0 50.0 69.4 75.0 66.7
73 Trichomoniasis 41.7 46.4 83.3 0.0 0.0
74 Other sexually transmitted diseases 79.7 78.9 78.7 81.3 79.5
75 Herpes genitalia 83.3 100.0 90.9 85.7 85.7
76 Acute hepatitis A 83.5 84.4 82.0 83.8 83.3
77 Acute hepatitis B 77.3 80.0 83.3 81.3 90.9
78 Acute hepatitis C 83.3 72.7 75.0 85.7 87.5
79 Acute hepatitis E 0.0 40.0 30.0 93.3 25.0
80 Leprosy 0.0 42.4 0.0 0.0 0.0
81 Legionnaires'disease 0.0 0.0 0.0 50.0 100.0
82 Leptospirosis 90.0 84.5 63.3 68.0 72.2
83 Rubella 0.0 50.0 0.0 0.0 0.0
84 Mumps 93.0 93.3 88.6 91.9 96.3
85 Other infectious diseases 85.2 83.2 84.6 85.0 81.5
86 Esophageal cancer 53.4 55.3 54.7 53.0 53.2
87 Stomach cancer 57.2 59.5 58.9 60.3 60.9
88 Liver cancer 55.5 54.8 55.8 55.1 55.0
89 Larynx cancer 61.6 60.7 61.0 59.6 62.7
90 Trachea, bronchus and lung cancers 61.8 61.7 60.2 59.7 60.6
91 Breast cancer 51.2 53.6 54.5 53.4 54.3
92 Cervical cancer 59.9 57.6 55.0 55.1 54.5
93 Uterine cancer 49.3 51.7 56.3 50.0 55.6
94 Prostate cancer 58.6 59.8 58.6 58.3 59.3
95 Colon and rectum cancers 61.3 61.0 60.3 61.0 62.5
96 Mouth cancer 48.8 48.8 48.3 48.0 49.0
97 Nasopharynx cancer 57.1 53.9 57.4 51.3 51.1
98 Cancer of other part of pharynx and oropharynx 58.1 57.5 50.9 55.1 58.3
99 Gallbladder and biliary tract cancer 60.8 59.8 58.8 59.3 61.7
100 Pancreatic cancer 57.1 53.8 55.6 55.1 53.6
101 Malignant melanoma of skin 46.2 51.7 51.0 52.1 52.5
102 Non-melanoma skin cancer 64.0 69.1 68.5 64.2 66.1
103 Ovarian cancer 46.7 45.6 46.9 47.4 46.5
104 Testicular cancer 52.0 54.6 56.3 44.4 55.6
105 Kidney cancer 51.1 53.3 51.4 51.3 53.8
106 Other urinary organ cancers 55.4 50.5 55.7 56.1 57.3
107 Bladder cancer 58.1 59.8 57.3 57.1 57.6
108 Brain and nervous system cancers 59.5 56.9 56.1 54.4 55.1
109 Thyroid cancer 56.6 52.0 48.7 48.5 49.4
110 Hodgkin's disease 54.3 55.2 52.9 52.9 54.8
111 Non-Hodgkin's lymphoma 52.3 50.9 50.6 50.6 51.6
112 Multiple myeloma 50.2 55.6 59.6 56.5 58.7
113 Leukemia 50.2 54.4 49.9 53.2 53.5
114 Bone and connective tissue cancer 41.0 41.8 37.9 40.6 39.0
115 Benign neoplasm of brain and other parts of central nervous system 54.7 56.0 55.7 51.1 51.4
116 Other neoplasms and unspecified cancer 70.7 71.8 69.3 68.6 71.2
117 Rheumatic heart disease 57.6 53.2 55.0 57.3 56.4
118 Ischemic heart disease 76.4 78.2 78.5 78.4 78.8
119 Ischemic stroke 77.3 77.7 78.9 79.0 80.1
120 Hemorrhagic and other non-ischemic stroke 76.7 79.1 79.9 80.3 81.0
121 Hypertensive heart disease 86.2 84.7 85.1 88.8 83.9
122 Cardiomyopathy and myocarditis 70.2 69.6 70.2 69.1 69.9
123 Atrial fibrillation and flutter 72.9 73.5 75.3 70.8 72.9
124 Aortic aneurysm 63.2 63.5 62.9 61.6 65.0
125 Peripheral vascular disease 76.4 75.2 73.3 73.2 77.5
126 Endocarditis 57.8 65.5 64.7 59.8 64.1
127 Hemorrhoid - - - - -
128 Varicose veins of lower extremities 77.1 80.9 79.8 82.3 82.1
129 Other cardiovascular and circulatory diseases 76.4 76.8 77.6 77.7 78.8
130 Chronic obstructive pulmonary disease 85.7 86.8 85.8 86.0 86.2
131 Pneumoconiosis 76.3 66.7 66.7 76.1 76.5
132 Asthma 88.9 87.9 87.5 86.8 86.3
133 Interstitial lung disease and pulmonary sarcoidosis 72.5 69.0 72.3 69.3 71.4
134 Other chronic respiratory  diseases 79.7 79.0 79.3 77.9 73.0
135 Cirrhosis of the liver 83.3 84.6 83.0 84.1 84.7
136 Peptic ulcer disease 86.7 85.9 85.5 85.7 87.3
137 Gastritis and duodenitis 82.5 84.5 85.6 85.5 87.4
138 Appendicitis 86.5 85.7 87.3 85.7 87.6
139 Paralytic ileus and intestinal obstruction without hernia 85.6 85.3 84.9 83.0 86.1
140 Inguinal or femoral hernia 71.9 74.5 72.9 70.1 71.2
141 Crohn's disease 63.3 62.7 64.3 59.2 62.6
142 Ulcerative colitis 75.0 68.2 68.8 70.2 72.4
143 Other noninfective inflammatory bowel disease 88.0 86.3 85.5 86.1 85.9
144 Vascular disorders of intestine 79.3 82.5 82.0 81.7 84.5
145 Gall bladder and bile duct disease 78.1 78.3 78.3 78.8 81.1
146 Pancreatitis 82.3 81.7 81.7 82.0 82.7
147 Gastroesophageal reflux disease 84.1 84.7 87.3 86.5 88.0
148 Other digestive diseases 80.4 81.2 81.3 81.2 82.2
149 Alzheimer's disease and other dementias 77.9 78.7 79.2 79.8 80.6
150 Parkinson's disease 75.6 76.3 76.6 76.9 78.2
151 Epilepsy 74.4 75.5 73.7 71.6 73.4
152 Multiple sclerosis 61.7 56.7 64.8 57.6 57.6
153 Migraine 82.9 83.9 85.3 83.1 86.0
154 Tension-type headache 85.7 84.7 86.2 86.2 87.0
155 Other neurological disorders 74.6 73.3 71.7 72.2 74.5
156 Schizophrenia 74.8 74.1 74.6 75.3 74.4
157 Alcohol use disorders 73.6 75.9 74.9 77.1 74.9
158 Opioid use disorders 62.0 100.0 61.7 71.9 64.9
159 Cocaine use disorders 100.0 0.0 0.0 0.0 0.0
160 Amphetamine use disorders 50.0 70.0 0.0 58.8 60.0
161 Cannabis use disorders 0.0 0.0 0.0 75.0 0.0
162 Other drug use disorders 85.2 85.4 85.2 87.4 82.2
163 Major depressive disorders 78.4 77.9 77.6 78.7 78.5
164 Dysthymia 78.6 75.0 70.7 69.2 75.6
165 Bipolar affective disorder 72.3 73.5 73.3 73.9 72.6
166 Panic disorder 78.1 80.0 81.9 78.3 77.8
167 Obsessive-compulsive disorder 66.7 71.4 71.4 80.0 73.9
168 Post-traumatic stress disorder 76.0 76.9 80.0 66.7 75.0
169 Other anxiety disorder 82.3 83.2 82.6 81.8 80.8
170 Anorexia nervosa 69.2 71.4 75.0 66.7 88.1
171 Bulimia nervosa 50.0 20.0 33.3 58.3 0.0
172 Other eating disorders 82.4 85.7 80.0 82.8 80.0
173 Autism 62.5 66.7 63.6 73.3 57.1
174 Asperger's syndrome 75.6 50.0 74.2 63.3 81.3
175 Attention-deficit hyperactivity disorder 72.7 64.3 68.2 78.1 74.4
176 Conduct disorder 66.7 69.2 69.2 81.8 81.0
177 Idiopathic intellectual disability 66.0 63.7 67.0 66.8 66.1
178 Borderline personality disorder 75.9 70.6 83.3 75.0 78.6
179 Other mental health and behavioral disorders 74.4 75.0 73.0 77.0 73.8
180 Diabetes mellitus 82.7 83.1 82.2 83.2 83.6
181 Acute glomerulonephritis 86.2 84.1 76.0 79.4 80.9
182 Chronic kidney disease due to diabetes mellitus 82.7 84.9 83.9 83.4 83.3
183 Chronic kidney disease due to hypertension 79.1 79.3 75.0 79.4 76.0
184 Chronic kidney disease unspecified 65.4 69.1 69.6 74.0 70.1
185 Tubulointerstitial nephritis, pyelonephritis, and urinary tract infections 86.8 86.9 87.2 87.7 88.7
186 Urolithiasis 86.1 85.3 85.4 85.4 86.7
187 Benign prostatic hyperplasia 71.5 73.3 72.7 72.0 76.9
188 Male infertility 41.7 45.5 41.1 35.0 38.1
189 Other urinary diseases 74.6 74.6 72.5 75.1 74.1
190 Urinary incontinence 78.3 78.0 77.3 78.9 78.4
191 Uterine fibroids 68.2 70.4 71.3 72.3 72.6
192 Polycystic ovarian syndrome 73.2 82.3 100.0 71.4 81.7
193 Female infertility 79.0 67.7 60.0 57.1 71.4
194 Endometriosis 69.0 70.7 67.4 65.8 65.0
195 Genital prolapse 73.1 73.9 71.7 75.2 71.6
196 Premenstrual syndrome 76.8 33.3 83.3 62.5 37.5
197 Other gynecological diseases 74.4 72.7 72.3 73.6 74.1
198 Thalassemias 0.0 100.0 0.0 66.7 0.0
199 Sickle cell disorders 0.0 100.0 0.0 0.0 0.0
200 G6PD deficiency 0.0 0.0 0.0 0.0 0.0
201 Other hemoglobinopathies and hemolytic anemias 70.2 70.6 71.7 71.1 74.3
202 Other endocrine, nutritional, blood, and immune disorders 78.4 76.9 76.8 74.2 73.4
203 Rheumatoid arthritis 69.1 78.1 67.7 78.6 73.1
204 Osteoarthritis 70.0 70.2 70.9 71.0 70.4
205 Low back pain 74.9 76.8 77.0 77.2 77.6
206 Neck pain 78.9 79.5 80.4 81.9 80.9
207 Gout 86.2 86.2 87.2 87.4 87.0
208 Systemic lupus erythematosus (SLE) 60.4 59.0 58.9 61.8 65.7
209 Other musculoskeletal disorders 76.2 74.9 75.1 75.1 75.5
210 Neural tube defects 22.2 20.0 22.2 16.7 16.7
211 Congenital heart anomalies 38.7 40.9 41.2 39.7 40.5
212 Cleft lip and cleft palate 29.6 25.4 18.2 22.2 18.5
213 Down's syndrome 66.7 72.2 66.7 60.0 83.3
214 Other chromosomal abnormalities 50.0 50.0 50.0 44.4 50.0
215 Other congenital anomalies 53.5 56.2 52.8 53.6 52.5
216 Eczema 80.5 81.7 81.3 80.0 78.6
217 Psoriasis 78.6 75.0 76.5 82.8 81.5
218 Cellulitis 87.3 87.7 88.5 88.1 87.6
219 Abscess, impetigo, and other bacterial skin diseases 82.4 83.3 85.3 85.7 86.3
220 Scabies 75.0 76.0 77.8 80.0 73.1
221 Fungal skin diseases 82.1 81.0 81.0 80.5 77.9
222 Viral skin diseases 88.8 88.0 90.4 89.4 88.6
223 Acne vulgaris 50.0 100.0 66.7 0.0 50.0
224 Alopecia areata 62.0 51.5 50.0 58.3 50.0
225 Pruritus 87.5 84.4 81.8 84.9 83.1
226 Urticaria 86.6 86.0 86.7 86.0 84.9
227 Decubitus ulcer 81.7 82.1 82.9 81.5 81.8
228 Other skin and subcutaneous diseases 81.5 80.4 82.5 78.8 80.2
229 Glaucoma 64.9 67.2 65.4 54.8 58.1
230 Cataracts 82.8 80.9 79.0 78.1 76.7
231 Macular degeneration 45.6 59.4 51.6 52.5 55.1
232 Refraction and accommodation disorders 44.0 50.8 53.1 48.3 54.8
233 Other hearing loss 75.8 77.2 74.8 71.0 73.5
234 Other vision loss 56.7 56.5 55.1 62.5 64.6
235 Other sense organ diseases 80.4 83.2 83.7 84.8 83.4
236 Dental caries 76.1 75.7 73.1 69.1 70.8
237 Periodontal disease 76.3 78.7 79.7 77.6 77.9
238 Sudden infant death syndrome 0.0 0.0 100.0 0.0 0.0
Units: %.

Comparison of relevance index by criterion

Comparing the relevance index between inpatient and outpatient care revealed that in all 17 regions, inpatient care had a lower relevance index than outpatient care (Fig. 2). The region with the most substantial difference was Sejong (inpatient: 22.4%, outpatient: 63.9%, difference: 41.5%p), followed by Chungcheongnam-do (inpatient: 64.2%, outpatient: 82.0%, difference: 17.8%p) and Gyeongsangbuk-do (inpatient: 62.6%, outpatient: 80.3%, difference: 17.7%p). Furthermore, the relevance index based on total out-of-pocket expenses was lower than that based on the number of patients in all 17 regions (Fig. 3). The region with the least significant difference was Seoul (87.1% by the number of patients, 83.7% by out-of-pocket expenses, difference of 3.4%p), and the region with the most significant difference was Gwangju (89.0% by the number of patients, 76.8% by out-of-pocket expenses, difference of 12.2%p).
Fig. 2

Five-year (2016–2020) weighted average of inpatient and outpatient relevance index based on the number of patients in 17 regions.

jkms-38-e130-g002
Fig. 3

Five-year (2016–2020) weighted average of the number of inpatients and out-of-pocket expense in inpatients relevance index based on the number of patients (inpatient) in 17 regions.

jkms-38-e130-g003

DISCUSSION

This study analyzed trends of relevance index over time (2016–2020) for each disease in each essential medical service field. The analysis results can be summarized as follows: among the essential medical service fields, the infection and cancer areas showed the highest and lowest relevance index values, respectively. Among the individual diseases, those characterized by a low relevance index were bone and connective tissue cancer (39.0%), ovarian cancer (46.5%), neural tube defects (16.7%), cleft lip and cleft palate (18.5%), and autism (57.1%). Regarding annual trends, the relevance index showed no significant improvement, overall. Moreover, in all 17 regions, inpatient care had a lower relevance index than outpatient care. Additionally, the relevance index based on total out-of-pocket expenses was lower than that based on the number of patients in all 17 regions.
Residents of any region have the right to receive high-quality essential medical services, and the government must ensure such a system. This study’s results can enable the identification of the insufficient essential medical service fields of each region and used as source data for placing a delivery system for such fields. To date, analysis of medical service regions, such as relevance index analysis, has tended to approach from the perspective of hospital divisions,10111220 which does not provide a detailed picture of the situation in the current ever-evolving medical specialty and subspecialty system anymore. Therefore, a shift to disease-based medical service region analysis, like the one adopted in this study, is necessary to provide more detailed improvement strategies. In particular, in this study, the disease classification system of the KNBD study,1617 which presented the ranking of disease burden as an indicator of DALYs, was used. By considering the RI ranking in this study together with the DALYs ranking by disease in the previous study,21 it will be possible to confirm the priority of establishing a medical service supply system for each disease in the region.
From the relevance index by the essential medical service field, the infection and cancer areas showed the highest and lowest relevance index values, respectively. This highlights the urgency of constructing strategies to improve the cancer area relevance index. Despite doubts raised about the adequacy of including cancer in the essential medical service fields, because cancer is not an emergency disease, cancer certainly falls under the category of the essential medical area when defined as a medical service that significantly affects life and health-related quality of life.14 Specifically, cancer care is not simply a matter of surgery or procedure but primarily requires continuous treatment such as chemotherapy, which is reported to be crucial for the cancer survival rate.22 Therefore, it is necessary to establish a system capable of providing high-quality cancer care within the community. Immediately improving the relevance index related to cancer surgery may be complex; hence, constructing and operating an integrated community care system for postoperative cancer patients can be considered an alternative. The capacity to provide high-quality cancer care for each municipal and provincial region must also be reinforced, and support measures at the national level must be established for the long term.
While the cancer area had the lowest relevance index in most regions, there were exceptions to this trend, indicating the need for a strategy to support weak areas in the affected regions. For example, Seoul and Busan had the lowest relevance index in the mental health area and Jeollanam-do in the cardiocerebrovascular area. This makes it possible to infer that vulnerable essential medical service fields may exist even in metropolitan cities, such as Seoul or Busan. Additionally, even among the region where the cancer area had the lowest relevance index, there were interregional variances in the cancer type. For example, leukemia showed the lowest relevance index in Gwangju, testicular cancer in Daejeon, and bone and connective tissue cancer in Ulsan. Given these inevitable variations in the regional relevance index status among the diseases of each essential medical service field by region, coping measures customized to regional characteristics of the relevance index must be established. A disease-specific approach to improving relevance index will help identify the necessary medical staffs and equipment, and ultimately contribute to improving mortality rates in the region.23
It is worth noting that there is no significant change in relevance index when looking at the annual change trend of relevance index. In Korea, various center designation projects, such as Regional Cancer Center,24 have been carried out to improve the level of essential medical care system in the region, but it seems difficult to grasp the effect when considering the trends of the relevance index from this study. The insufficient level of improvement in relevance index supports the need for effective strategies to further strengthen the level of the essential medical care system in the region. Rather, the relevance index even decreased in the maternal and neonatal areas (from 79.1% in 2016 to 77.4% in 2020). It is necessary to fundamentally reexamine the delivery system improvement projects carried out in the maternal and neonatal areas, such as the Supporting Program for Obstetric Care Underserved Areas.25 On the other hand, the relevance index slightly increased in the cardiocerebrovascular area (from 76.0% in 2016 to 79.7% in 2020), and it is necessary to examine whether the expansion of the Regional CardioCerebroVascular Center’s designation contributed to this phenomenon.2627
Notably, the relevance index based on total out-of-pocket expenses are lower than the number of patients. This phenomenon was noticeable in all essential medical service fields in metropolitan areas, such as Busan, Daegu, and Ulsan, as well as in generally vulnerable medical regions, such as Gangwon-do and Chungcheongnam-do. This suggests that patients spend more out-of-pocket expenses when receiving essential medical services in other regions. However, the patients may receive essential medical services in other regions due to the high severity of the disease, and this severity may worsen during transit to another region. This aspect must be considered by future research by examining the treatment results of patients who have received essential medical services in regions other than their regions. If no significant difference is found in patient outcomes between the treatments in the residential and other regions, encouraging patients to receive treatment in their residential regions can help increase the health insurance cost-effectiveness. In other words, this indicates that expanding medical institutions with the capacity to provide high quality essential medical care in the region can have advantages not only in terms of equity but also in terms of financial efficiency.
This study examined only out-of-pocket expenses of health insurance, but receiving treatment in a different region involves additional costs for transport and the accompanying caregiver (if any) and additional time, doubling the total costs.28 If local residents travel to other regions to receive essential medical services because there is no reliable healthcare delivery system in the residential region, such additional costs are incurred by them alone. Therefore, the total medical expenses spent in other regions can help estimate the costs that can be saved by building a local healthcare delivery system that ensures essential medical services.
This study has some limitations, and proposals are presented to address these limitations. First, emergency cases could not be identified in this study. For the cardiocerebrovascular area, for example, it is of utmost importance whether emergency care was provided within the crucial hour. In this study, however, relevance index analysis considered emergency and non-emergency cases combined. It does not mean that an essential health care system should be established only in emergency situations, but the inability to provide adequate medical care in the region even in emergency situations would be a bigger problem. In future research, relevance index analysis must examine whether or not the cases reviewed are emergency cases in each essential medical service field.
Second, the relevance index analysis of the trauma care area, an important essential medical service field, could not be performed. In various other injuries, such as severe trauma, it is crucial to have an emergency care delivery system capable of providing treatment within the crucial hour, as in cardiocerebrovascular disease, and build a local management system. Since the data from the National Health Insurance Service do not clearly indicate the mechanism of injury, it was difficult to analyze the relevance index in the trauma area fitting the disease classification system criteria of the KNBD study. In future research, it is necessary to reinforce the relevance index analysis of the trauma care area by using data that can confirm injury cases, such as the discharge injury in-depth survey data.
Third, the essential medical services quality provided could not be accurately assessed; the relevance index analysis only concerned whether inpatient or outpatient care was provided. In addition, it was difficult to ascertain whether the medical services provided met the expectations of patients and caregivers. In future research, this must be assessed for treatment outcomes and patient or caregiver satisfaction and experience. For example, it would be a noteworthy undertaking to examine whether there is a significant difference in the five-year survival and patient experience between cancer patients treated in their own and other regions.
Fourth, relevance index analysis must also include uncovered medical expenses. In this study, relevance index analysis was performed only on out-of-pocket expenses, and whether the inclusion of uncovered expenses will negatively affect the relevance index must be examined. If it worsens the relevance index relative to the total medical expenses compared with this study’s estimated value, the need for a medical institution providing high-quality essential medical services in the concerned region becomes more compelling.
Finally, adopting this study’s research methodology, the scope of research can be extended to analyzing the relevance index at the district and county level or in subregional units, contributing to creating subregional public health service plans or regional healthcare delivery plans. For cardiocerebrovascular and maternal and neonatal areas, specifically, having a healthcare delivery system is more advantageous at the subregional level (districts and counties) over the regional level (municipalities and provinces). Analysis of the subregional relevance index at the subregional level can help detect medically disadvantaged areas within a region.
As a strategy to reduce regional health inequalities, establishing an independent regional healthcare delivery system to provide essential medical services is drawing increasing attention. This undertaking requires extended time and continuous monitoring of the system level. The relevance index of each disease in each essential medical service field analyzed in this study can provide a good indicator to monitor the level of regionally independent essential medical services. The study’s methodology and results can form the basis for building a system capable of relevance index monitoring in a comprehensive way at the national level.

Notes

Funding: This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (HA21C0107). This study was also supported by a fund of the Task Forces to Support Public Health and Medical Services in Ulsan Metropolitan City.

Disclosure: The authors have no potential conflicts of interest to disclose.

Author Contributions:

  • Conceptualization: Kim YE, Pyo J, Ock M, Yoon SJ.

  • Data curation: Kim YE, Pyo J, Lee H, Jeong H, Park YK, Seo JW, Ock M.

  • Formal analysis: Park YK, Seo JW, Ock M.

  • Funding acquisition: Ock M, Yoon SJ.

  • Investigation: Kim YE, Pyo J, Ock M.

  • Methodology: Kim YE, Pyo J, Ock M, Yoon SJ.

  • Project administration: Ock M, Yoon SJ.

  • Software: Lee H, Jeong H.

  • Supervision: Ock M, Yoon SJ.

  • Validation: Kim YE, Pyo J, Lee H, Jeong H, Ock M.

  • Visualization: Pyo J, Lee H, Jeong H, Park YK, Seo JW.

  • Writing - original draft: Kim YE, Pyo J, Ock M.

  • Writing - review & editing: Kim YE, Pyo J, Lee H, Jeong H, Park YK, Seo JW, Ock M, Yoon SJ.

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SUPPLEMENTARY MATERIALS

Supplementary Table 1

List of 260 diseases
jkms-38-e130-s001.doc

Supplementary Table 2

Trends in relevance index in Seoul by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s002.doc

Supplementary Table 3

Trends in relevance index in Busan by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s003.doc

Supplementary Table 4

Trends in relevance index in Daegu by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s004.doc

Supplementary Table 5

Trends in relevance index in Incheon by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s005.doc

Supplementary Table 6

Trends in relevance index in Gwangju by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s006.doc

Supplementary Table 7

Trends in relevance index in Daejeon by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s007.doc

Supplementary Table 8

Trends in relevance index in Ulsan by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s008.doc

Supplementary Table 9

Trends in relevance index in Sejong by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s009.doc

Supplementary Table 10

Trends in relevance index in Gyeonggi-do by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s010.doc

Supplementary Table 11

Trends in relevance index in Gangwon-do by disease related to essential medical service (Based on the number of inpatients)
jkms-38-e130-s011.doc

Supplementary Table 12

Trends in relevance index in Chungcheongbuk-do by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s012.doc

Supplementary Table 13

Trends in relevance index in Chungcheongnam-do by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s013.doc

Supplementary Table 14

Trends in relevance index in Jeollabuk-do by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s014.doc

Supplementary Table 15

Trends in relevance index in Jeollanam-do by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s015.doc

Supplementary Table 16

Trends in relevance index in Gyeongsangbuk-do by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s016.doc

Supplementary Table 17

Trends in relevance index in Gyeongsangnam-do by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s017.doc

Supplementary Table 18

Trends in relevance index in Jeju-do by disease related to essential medical service (based on the number of inpatients)
jkms-38-e130-s018.doc
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