Evaluation of occupational health service systems in small- and medium-sized industries in Korea

Objectives: To establish a system of analytical methodology that can be used to evaluate an occupational health service system, to evaluate the performance of different types of the system in small- and medium-sized industries using the evaluation model, and to identify factors which influence the performance of an occupational health service system. Methods: The input-output-outcome aspects of two different systems, capitation-based Group health services and fee-for-service-based Individual health services, were examined, based on a causal model. Each causal relationship in the model was tested for its statistical significance by the linear regression technique based on the ordinary least square method. Data from 16 enterprises in the Group-type, 17 enterprises in the Individual-type, and 32 enterprises in the Transitional Group-type were used in the analyses. Results: In the Group model, enterprises utilized fewer resources for occupational services, their workers were provided with more services when services such as medical examinations were supplied directly by the system, and they had worse outcome measures of health and industrial injuries. The latter was the result of less input and fewer services, the supply of which was not within the direct control of the system, such as compliance with the recommendation to install machine safety devices and the proper maintenance and operation of these devices. Conclusions: Although study results revealed problem areas in the performance of the Group system, the study found a potential for an effective and efficient system in the Group-type with efforts geared to the better follow-up of work environment problems.