A Sick Benefit Scheme Reduces Unmet Healthcare Needs: An Natural Experiment in Seoul

Abstract   South Korea experiences four times more unmet healthcare needs than OECD countries (11.6% and 2.6% respectively). Unmet healthcare needs are caused by the double burden of direct and indirect costs including income loss, and OECD countries operate a sickness benefit scheme to resolve sudden loss of pay. Seoul introduced the first sickness benefit system, Seoul-Type Paid Sick Leave Support (hereinafter Seoul Sick Leave), for self-employed national healthcare insurance subscribers to reduce the rate of unmet healthcare needs. By comparing the amount of increasing medical expenses between the beneficiary and non-beneficiary before (2018) and after (2019-2020) the introduction of the system, the study was intended to confirm the reduced unmet healthcare needs. This study used data from the National Health Information Database (NHID) and the difference in differences (DID) analytic framework. 96 and 121 patients were included in benefit and non-benefit cohorts, respectively. As a result, the beneficiary group’s expenses were smaller than those of the non-beneficiary group (coef.=-1.24, p = 0.026). However, the beneficiary group had a greater amount of increase in hospitalization expenses before and after the introduction than the non-beneficiary group did (coef.=1.66, p = 0.005). Our finding showed that the Seoul Sick Leave helped the precarious workers as they were able to use inpatient services when they needed. If it is to be scaled up to the national level, it should be applied all people to enhance universal health insurance in Korea. Key messages • Identified the effectiveness of the first sickness benefit system as it helped the precarious workers as they were able to use inpatient services when they needed. • By financially supporting them, the Seoul Sick Leave support can achieve health promotion through early detection and treatment.


Background:
Sexual harassment (SH) continues to be a significant public health problem, especially among women.SH and other types of harassment and derogatory treatment/bullying exist at many academic workplaces.The aim of this study is to explore how SH relates to other forms of harassment among staff at a large Swedish university, separated by gender.

Methods:
Using data from a web-based survey sent out to all staff in November 2019 (response rate 33%), a multiple logistic regression analysis was performed.Exposure to SH was defined as having experienced at least one of ten defined SH behaviours related to work.Exposure to harassment (other than sexual) was defined as having experienced violation of one ´s dignity associated with one of the Swedish seven legal grounds for discrimination: sex, transgender identity or expression, ethnicity, religion or other belief, disability, sexual orientation or age.Exposure to derogatory treatment was defined as having experienced undesirable negative behaviours, such as withholding information, derogatory comments or exclusion.All SH, harassment and derogatory treatment took place during the last 12 months.

Results:
Preliminary results show a sixfold increased risk among women subjected to SH to also experience harassment, a three times higher risk to experience derogatory treatment and a seven times higher risk to experience multiple forms of harassment (two or more forms of harassment or derogatory treatment) compared to women unexposed to SH.The elevated risk remained after adjusting for relevant background variables.The pattern was similar among men but with lower prevalence of SH, harassment and derogatory treatment.

Conclusions:
The results indicate that individuals subjected to SH at work have an increased risk of experiencing other types of harassment or derogatory treatment.This new information is relevant to consider in prevention of SH and harassment in academia.

Key messages:
The South Korea experiences four times more unmet healthcare needs than OECD countries (11.6% and 2.6% respectively).Unmet healthcare needs are caused by the double burden of direct and indirect costs including income loss, and OECD countries operate a sickness benefit scheme to resolve sudden loss of pay.Seoul introduced the first sickness benefit system, Seoul-Type Paid Sick Leave Support (hereinafter Seoul Sick Leave), for self-employed national healthcare insurance subscribers to reduce the rate of unmet healthcare needs.By comparing the amount of increasing medical expenses between the beneficiary and non-beneficiary before (2018) and after (2019-2020) the introduction of the system, the study was intended to confirm the reduced unmet healthcare needs.This study used data from the National Health Information Database (NHID) and the difference in differences (DID) analytic framework.96 and 121 patients were included in benefit and non-benefit cohorts, respectively.As a result, the beneficiary group's expenses were smaller than those of the non-beneficiary group (coef.= -1.24,p = 0.026).However, the beneficiary group had a greater amount of increase in hospitalization expenses before and after the introduction than the non-beneficiary group did (coef.= 1.66, p = 0.005).
Our finding showed that the Seoul Sick Leave helped the precarious workers as they were able to use inpatient services when they needed.If it is to be scaled up to the national level, it should be applied all people to enhance universal health insurance in Korea.

Key messages:
Identified the effectiveness of the first sickness benefit system as it helped the precarious workers as they were able to use inpatient services when they needed.

Background:
From the beginning of 2020, the COVID-19 pandemic imposed many changes in the organization of our personal and professional life, allowing a shift to teleworking and hybrid working arrangements worldwide.The persistence of this condition determined the integration of these changes in the daily routine, and our aim was to investigate how these changes could affect workers' Quality of Life (QOL) in the long run.

Methods:
An online questionnaire was administered to 650 workers employed in an Italian company in July 2021.The domains considered were socio-demographic characteristics, QOL (WHOQOL-bref and Healthy Days), lifestyle, health status, physical activity, and work-related factors.Comparisons were performed with non-parametric tests.
Results: Among the 332 respondents (response rate = 51.1%),79.2% were white-collar workers.The concern for the pandemic affected workers' QOL, especially in the physical health and the environmental domains (p < 0.001 and p = 0.001, respectively), with lower values in subjects reporting the highest values of concern.A similar effect was found also for healthy days concerning physical and psychological health, and the ability to perform usual activities (p = 0.003, p = 0.003, and p = 0.029, respectively).As well, changes in working arrangements significantly affected the environmental and physical domains (p = 0.023 and p = 0.015, respectively) and the ability to do usual activities (p = 0.011), with lower values in those who interrupted the working activity.Workers whose activity required a shift to teleworking reported higher scores in the physical health domain (p = 0.041) and a higher number of days with good physical health (p = 0.002), while a lower number of days with good psychological health (p = 0.006).

Conclusions:
These preliminary data revealed that organizational strategies adopted in working scenarios to contain the spread of COVID-19 may have an impact on workers' QOL, as well as the concern for the pandemic.

Key messages:
Changes in the working arrangements due to pandemic may negatively affect the workers' Quality of Life, especially for those who had to interrupt their working activity.The shift to telework, even if appearing to be beneficial for physical health perception, seems to negatively affect workers' psychological health.
results indicate that individuals subjected to sexual harassment at work have an increased risk of experiencing other types of harassment or derogatory treatment.Findings indicating a relationship between sexual harassment and other types of harassment or derogatory treatment may be valuable for counteracting the problem.
2 Health Policy and Management, Korea University, Seoul, South Korea 3 Center for Labour and Health, People's Health Institute, Seoul, South Korea 4 Division of Health and Medical Sciences, The Cyber University of Korea, Seoul, South Korea Contact: sara521@korea.ac.kr