Soonman Kwon

This study analyzes Korea’s fragmented governance for healthy ageing and long-term care amid rapid super-ageing, and proposes reforms for a sustainable, integrated care system. We reviewed international paradigms (compression of morbidity, ageing in place) and examined governance reforms in Japan and Thailand, focusing on financing and administrative structures; we then assessed Korea’s policy status and drew reform options. Findings indicate that aligning financial incentives is pivotal for integrated care: Japan combines decentralized insurer accountability with performance-based incentives, and Thailand uses a local coordinated fund that links health promotion with long-term care. Korea’s financial and organizational fragmentation weakens local-level incentives for preventive and integrated care. We conclude that Korea should realign goals and incentives across health insurance, long-term care insurance, and health promotion funds, and adopt mechanisms such as shared-savings to reward local efforts that advance healthy ageing.

Background: Primary care physicians perform a comprehensive role by providing continuous, patient-centered, and accessible healthcare and establishing connections with specialized care. However, the association between the supply of primary care physicians and mortality rates in South Korea has not been thoroughly investigated.Methods: This study utilized data from 229 si-gun-gu in South Korea from 2016 to 2020. The densities of primary care physicians, physicians in functional primary clinics, specialists in primary care facilities, and active physicians per 100,000 people were independent variables. Age-adjusted all-cause mortality and cause-specific mortality rates per 100,000 individuals were the dependent variables. Negative binomial regression, negative binomial regression with a pseudo-panel approach, and geographically weighted regression were used to analyze the data.Results: Our study revealed a significant negative association between the density of primary care physicians and all-cause mortality. An increase in a primary care physician per 100,000 population was significantly linked to a 0.11% reduction in all-cause mortality (incidence rate ratio, 0.9989; 95% confidence interval, 0.9983–0.9995). Similar associations have been observed between mortality rates owing to cardiovascular diseases, respiratory tract diseases, and traffic accidents.Conclusion: This study provides evidence that having a higher number of primary care physicians in South Korea is associated with lower mortality rates. Future research should consider better indicators that reflect the quality of primary care to better understand its impact on population health outcomes. These findings emphasize the significance of strengthening primary care in the South Korean healthcare system to improve the overall health and wellbeing.

Public long-term care insurance (LTCI), which provides home and institutional care benefits, was introduced in July 2008 in South Korea. This study aims to evaluate the effects of the introduction of LTCI on older people's medical service use, including outpatient visits, inpatient services and longer stays (181 days or longer) in hospitals by implementing a quasi-experiment design with a generalised difference-in-difference method. The results showed that the introduction of LTCI did not change the use of outpatient medical services, although the medical costs of older people who used medical services at least once decreased by 9.4%. For the inpatient services, hospitalisation rates declined by 2.7% as a result of the LTCI. Length of stay and inpatient expenses decreased by 15.6 and 9.5%, respectively. For older people of LTC grade 2, eligible for long-term care facilities (LTCF), prolonged hospitalisation rates decreased by 1.6% due to the LTCI. In conclusion, the introduction of LTCI in South Korea has contributed to decreasing the use of inpatient services and longer stays in hospitals, which suggests that the utilisation of LTCF has become a substitute for some social admissions in hospitals.

본 논문에서는 거스(girth) 기어용 대형 링 기어 구동을 위한 피니언에 대한 굽힘강도 해석을 수행하였다. 이를 위해 기존 인벌류트 치형 기반 링 기어를 핀 휠로 구성한 e-PGS(external pinwheel gear set) 시스템을 고려하였다. 이의 설계제원 중 롤러직경계수가 증가하면 피니언 이의 크기가 감소하며 그에 따라 이뿌리 부 또한 얇아지므로 굽힘응력은 증가하며, 중심거리증가계수의 증가는 디덴덤의 감소, 그리고 어덴덤과 전 높이에 걸쳐 이 두께가 증가하는 치 형상으로 귀결되며, 접촉력 및 접선력에 미치는 영향은 거의 없음을 확인하였다. 하지만 중심거리증가계수의 증가에 따라 형상계수가 증가하여 이뿌리 부 굽힘응력은 큰 폭으로 감소하는 경향을 확인할 수 있었다.