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dc.contributor.authorLee, Hayoung
dc.contributor.authorRobinson, Courtland
dc.contributor.authorKim, Jaeshin
dc.contributor.authorMcKee, Martin
dc.contributor.authorCha, Jiho; orcid: 0000-0003-1212-5671; email: jiho.cha@manchester.ac.uk
dc.date.accessioned2021-06-29T15:40:03Z
dc.date.available2021-06-29T15:40:03Z
dc.date.issued2020-06-29
dc.date.submitted2020-01-12
dc.identifierhttps://chesterrep.openrepository.com/bitstream/handle/10034/625083/13031_2020_Article_284_nlm.xml?sequence=2
dc.identifierhttps://chesterrep.openrepository.com/bitstream/handle/10034/625083/13031_2020_Article_284.pdf?sequence=3
dc.identifier.citationConflict and Health, volume 14, issue 1, page 41
dc.identifier.urihttp://hdl.handle.net/10034/625083
dc.descriptionFrom Springer Nature via Jisc Publications Router
dc.descriptionHistory: received 2020-01-12, accepted 2020-06-02, registration 2020-06-03, pub-electronic 2020-06-29, online 2020-06-29, collection 2020-12
dc.descriptionPublication status: Published
dc.descriptionFunder: Korea Institute for National Unification; Grant(s): N/A
dc.description.abstractAbstract: Background: To gain insights into the socio-economic and political determinants of ill health and access to healthcare in North Korea. Methods: A retrospective survey using respondent-driven sampling conducted in 2014–15 among 383 North Korean refugees newly resettling in South Korea, asking about experiences of illness and utilization of healthcare while in North Korea, analyzed according to measures of political, economic and human rights indicators. Results: Although the Public Health Act claims that North Korea provides the comprehensive free care system, respondents reported high levels of unmet need and, among those obtaining care, widespread informal expenditure. Of the respondents, 55.1% (95%CI, 47.7–63.7%) had received healthcare for the most recent illness episode. High informal costs (53.8%, 95%CI, 45.1–60.8%) and a lack of medicines (39.5%, 95%CI, 33.3–47.1%) were reported as major healthcare barriers resulting in extensive self-medication with narcotic analgesics (53.7%, 95%CI, 45.7–61.2%). In multivariate logistic regressions, party membership was associated with better access to healthcare (Adjusted OR (AOR) = 2.34, 95%CI, 1.31–4.18), but household income (AOR = 0.40, 95%CI 0.21–0.78) and informal market activity (AOR = 0.29, 95%CIs 0.15–0.50) with reduced access. Respondents who could not enjoy political and economic rights were substantially more likely to report illness and extremely reduced access to care, even with life-threatening conditions. Conclusions: There are large disparities in health and access to healthcare in North Korea, associated with political and economic inequalities. The scope to use these findings to bring about change is limited but they can inform international agencies and humanitarian organizations working in this unique setting.
dc.languageen
dc.publisherBioMed Central
dc.rightsLicence for this article: http://creativecommons.org/licenses/by/4.0/
dc.sourceeissn: 1752-1505
dc.subjectResearch
dc.subjectHealth disparities
dc.subjectAccess to healthcare
dc.subjectPolitical inequality
dc.subjectHealth system
dc.subjectNorth Korea
dc.titleHealth and healthcare in North Korea: a retrospective study among defectors
dc.typearticle
dc.date.updated2021-06-29T15:40:03Z
dc.date.accepted2020-06-02


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