KIHASA has published Health and Social Welfare Review, Vol. 42, No. 3.

• ■Editorial
  Multidisciplinary Research for Social Well-Being and Mental Health

• ■Articles
  1. COVID-19 Survivors' Experiences of Stigma and Coping in the Workplace
  2. Analysis of Effect of Employment Stability by Income Level on Health Care Use
  3. Facilitators and Barriers of Smoking Cessation among Users of Smoking Cessation Clinics in Public Health Centers
  4. An Explorative Study on the Experiences and Meanings of Mental Health Help-Seeking among Young People in Korea: Implications for Consumer-Oriented Mental Health Service Design
  5. Development of Essential Items for Personal Health Record (e-PHR) for Integrated Healthcare Service for People with Brain Lesions
  6. Exploring the Effect of Job Stress on Job Satisfaction of Social Service Workers: The Mediating Effect of Organizational Commitment and Career Commitment
  7. Analysis of the Factors Affecting Children's Discrimination Based on Academic Performance: Focused on Elementary School Boys in Community Child Center
  8. How Do Adolescent Smokers Evade Cigarette Sales Restrictions?: Focusing on How They Purchase and Acquire Cigarettes
  9. Patterns of Social Participation and Depressive Symptoms among Older Adults with and without a Spouse
  10. Timing of Early Childcare use and Child Development: A Quantile Regression
  11. Introduction of Child Maltreatment Fatality Review to the Korean Child Protective System
  12. Factors Related to University Students' COVID-19 Vaccination Behavior: With a Focus on One University in Chungchoengnam-do
  13. Unmet Needs among Patients with Hypertension or Diabetes during the COVID-19 Pandemic by Household Income
  14. The Psychological Mechanism of Ageism among Korean Young and Middle Aged Adults: Age-based Social Identity and Aging Anxiety
  15. A Study on the Policy Simulation Using Welfare Accounts from the Perspective of SNA
  16. Factors Influencing the Attitudes toward the Advanced Directives of Patients with Cancer: Focusing on the Psychological, Family, and Social Aspects
  17. Leading Policy Acts Detection and COVID-19 Countermeasure Legislation's Impact Evaluation: Legal Code Citation Network Analysis on the Health and Welfare Policies
  18. A Study on Factors of Care Resources Use among the Korean Elderly
  19. Examining the Effect of Health Status on Changes in Life Satisfaction in Older Adults
  20. Changes in Emergency Medical Services Utilization Before and After COVID-19: Focused on General Hospitals and Higher-Tier Medical Institutions
  
  

Editorial: "Multidisciplinary Research for Social Well-Being and Mental Health," Kim, Keon-Yeop, Kyungpook National University

Articles:

• 1."COVID-19 Survivors' Experiences of Stigma and Coping in the Workplace," Kim, Min Ah & Sung, Jimin, Sungkyunkwan University
  This study aimed to explore the workplace stigma and coping experiences COVID-19 survivors had as they returned to work. We conducted in-depth interviews with 15 COVID-19 survivors. Fifteen subthemes have emerged within three main themes: a) workplace stigma toward COVID-19 survivors, b) coping strategies to avoid or change the stigma towards COVID-19 survivors, and c) service needs for mitigating social stigma towards COVID-19 survivors. Participants experienced various forms of stigmatization and thus felt intimidated in the workplace. They engaged with passive as well as active coping strategies to avoid or change stigma, and emphasized the needs for psychological counseling, peer mentoring, education, and awareness campaigns. During the COVID-19 pandemic, this study suggested education and training for the COVID-19 survivors to alleviate stigma and support successful reentry to society
  
  

• 2." Analysis of Effect of Employment Stability by Income Level on Health Care Use," Moon, Seokjun, KIHASA; Lee, Jaeeun, KIHASA; Kim, Heenyun, Health Insruance Review & Assessment Service; Kim, Hyeyun, KIHASA; Oh, Sujin, KIHASA; Yeo, Nageum, KIHASA
  The purpose of this study is to analyze the factors influencing health care use by income level and employment stability. Health care use is confined here to outpatient care use and this study examines its quantitative (number of outpatient use per year) and qualitative (outpatient health care expenses per year) characteristics. This study used the Korea Health Panel Survey (2013-2018) for data. A total of 433,238 cases (11,909 subjects) were extracted based on employment status and medical security type. In order to estimate the effect of income, the subjects were divided into 4 income groups. We employed Panel Negative Binomial Regression and Fixed-effect Panel Regression to identify factors of the number of health care services used and the volume of health care expenses, respectively. Our analysis found that factors affecting health care use were gender, age, education level, married status, employment status, employment insurance payments, health insurance eligibility, industrial accident insurance payments, private insurance payment, and chronic disease status. In particular, as for employment status, which is the main interest of this study, it was confirmed that temporary-daily workers and self-employed use less health care than regular-full time worker with relatively high employment stability. Also, there were significant differences in some variables by income sub-groups in health care use. This study suggests that policy design that considers not only income but also employment stability is needed to ensure the national health security such as the policy of reorganizing national health insurance imposition and expansion of employment insurance and industrial accident insurance range.
  
  

• 3."Facilitators and Barriers of Smoking Cessation among Users of Smoking Cessation Clinics in Public Health Centers," Ahn, Young Mee, Inha University; Lee, Hun Jae, Inha University; Sohn, Min, Inha University; Kim, Younhee, Inha University; Cho, Jung Ae, Inha University; Lee, Sangmi, Dongyang University
  The purpose of the study was to explore facilitators and barriers of smoking cessation among users of smoking cessation clinics in public heath centers. This study was a qualitative research with data collected through series of focus group interview. We interviewed five focus groups comprising 4-5 participants each in persons. The interviews were audio-recorded and transcribed verbatim and analysed with qualitative content analysis. The data of total 22 participants were analyzed. The analysis resulted in 4 categories on facilitators and 3 categories on barriers of smoking cessation. The categories of facilitators of smoking cessation were (a) discomfort of smoking, (b) strategies of smoking cessation, (c) benefits of smoking cessation clinics, and (d) positive experience of smoking cessation. The categories of barriers of smoking cessation were (a) ineffective service of smoking cessation clinic, (b) a permissive smoking environment, and (c) a craving to smoking. The services provided by smoking cessation clinics served as guidance to help smokers quit. In order to increase the smoking cessation rate among users of smoking cessation clinics, it is necessary to provide more tailored services such as counseling and nicotine replacement therapy to meet user’ needs.
  
  

• 4."An Explorative Study on the Experiences and Meanings of Mental Health Help-Seeking among Young People in Korea: Implications for Consumer-Oriented Mental Health Service Design," Park, Jihye & Lee, Sun Hae, Chung-Ang University
  The purpose of the study was to explore the experiences and meanings of mental health help-seeking among young people in Korea and suggest directions for mental health service policy and practice specific to this population. Five study participants who had experienced mental health problems such as depression were recruited via purposive sampling and invited to an individual in-depth interview. They were asked about perceived symptoms and needs for help at the onset of the problem, searching for helping resources and decision-making, and process of service use and related experiences. The qualitative data were analyzed by following an inductive coding process, and the meaning units drawn from the data were grouped into 5 categories and 14 subcategories. The 5 categories are ‘life full of pain and instability’ ‘cumbersome process of help seeking’ ‘first-person experience of service use’ ‘process of getting more and losing less’ ‘young consumers’ evaluations and suggestions’. In conclusion, implications for provider reflection on her practice and directions for service delivery were made as ways to help facilitate help-seeking behaviors among young people who hold an identity as a mental health service consumer.
  
  

• 5."Development of Essential Items for Personal Health Record (e-PHR) for Integrated Healthcare Service for People with Brain Lesions," Kim, Jae Hak, Kim, Kyu Min, and Rhee, Hyun Sill, Korea University
  
  This study survey the essential items of personal health record(PHR) for the integrated healthcare service of people with brain lesions and importance priority were identified. For this, we analyzed previous literature and delphi survey, analytic hierarchy process(AHP), were conducted this study on 60 people(disability, guardians, field experts and professors). In the Delphi survey, reliability and content validity ratio were investigated, and the relative importance and priority of items were derived through an expert group using the hierarchical analysis method. As a result, for the composition necessary for the activation of personal health records of persons with brain lesions, 6 high-order factors and 62 low-level factors were compared in pairs. For details of each item, “Health Record”10 details, “Management, Notification” 5, “Information Provision” 7, “Linkage Scope” 7, “Rehabilitation Area” 10, “Policy System” 7, “efficiency and level of help” was composed of 16 questions. Based on these analysis results, this study presented practical and policy implications for activating personal health records and establishing a system for people with brain lesions.
  
  

• 6."Exploring the Effect of Job Stress on Job Satisfaction of Social Service Workers: The Mediating Effect of Organizational Commitment and Career Commitment," Shin, Changhwan, Kyungpook National University; Park, Jungkyu, Kyungpook National University; Jeong, Younghoe, Kyungpook National University
  
  The Community Service Investment Program has been implemented for the purpose of improving the quality of social services by way of promoting market competition. The purpose of this study is to examine the role of organizational commitment and career commitment perceived by workers in the relation with job stress and job satisfaction through a double mediation model. The results revealed that job stress was negatively associated with job satisfaction, organizational commitment, and career commitment. Moreover, the relationship between job stress and job satisfaction was partially mediated by career commitment, while career commitment and organizational commitment were serially mediate the relationship between job stress and job satisfaction. Through these analysis results, several implications were derived for improving the service quality and performance of the local community service investment project. As the importance of career commitment increases, there is a need for provider-centered human resources management. In this regard, this study suggests that service provider agencies and local authorities should develop and implement education and training programs that can be helpful for social service workers in their career management. In addition, a job stress management plan was presented to increase job satisfaction among service providers.
  
  

• 7."Analysis of the Factors Affecting Children's Discrimination Based on Academic Performance: Focused on Elementary School Boys in Community Child Center," Woo, Jungja, Kyungmin University
  
  The purpose of this study is to investigate the factors that affect children’s discrimination based on academic performance. The subjects of this study were 325 elementary school boys who responded to the third survey of the second child panel survey at the community child center. The independent variables are family economic level, family type, aggression, depression, stress, existence of sibling, existence of friends, community social capital, neglectful parenting attitude, abuse parenting attitude, human rights consciousness, human rights information, and experience of discrimination. SPSS PASW Statistics 25.0 was used to analyze the exploratory factor analysis, reliability analysis, frequency analysis, descriptive statistics, correlation analysis, and multiple regression analysis. The results of this study showed that human rights consciousness, family economy level, experience of discrimination damage, and aggression had a significant effect on children’s discrimination based on academic performance. The results of this study emphasize that children should try to strengthen their human rights consciousness to respect and sympathize with others in order to reduce their behavior by discriminating against academic performance. And it is suggested that negative emotional management such as wound healing and aggression due to discrimination damage is also necessary.
  
  

• 8."How Do Adolescent Smokers Evade Cigarette Sales Restrictions?: Focusing on How They Purchase and Acquire Cigarettes," Her, Wonbin, Pukyong National University; Oh, Young Sam, Pukyong National University
  
  This study aims to examine the channels used by adolescent smokers who purchase or acquire cigarettes. In addition, this study examines how adolescents’ demographic factors and smoking-related factors are related to the methods used by adolescent smokers. To address this research purpose, in-depth interviews were conducted with 10 adolescent smokers to collect data. Using case study approach, this study analyzed the qualitative data. In this study, adolescent smokers used forged ID cards, proxy purchase, or purchasing cigarettes through online/off-line “evading stores.” Furthermore, the more similar the appearance to an adult, the more direct purchase methods using a forged ID card was used. Also, the proxy purchase(indirect purchase) method was used when the appearance looked like a minor. The study suggested mandatory installation of an ID identifier, a total amount of cigarettes, and prohibition of online cigarette sales, distribution, and advertising as realistic alternative to prevent adolescents from purchasing and acquiring cigarettes. This study would contribute to the reducing ease of cigarette purchase by understanding how adolecents purchase and acquire cigarette. furthermore, this study would contribute to the development of ways to prevent and control adolescent smoking. Ultimately, this study expect to improve adolescent health.
  
  

• 9."Patterns of Social Participation and Depressive Symptoms among Older Adults with and without a Spouse," Kim, Eun-joung, Jeju Research Institute; Min, Joohong, Jeju Research Institute
  
  The article attempts to examine the types of social participation of older adults and the association between patterns of social participation and depressive symptoms according to the marital status by using data from the 7th year (2018) Korean Longitudinal Study of Aging (KLoSA). In our analysis of 4,334 older adults over the age of 65 (2,945 with a spouse and 1,389 without), both the married and unmarried showed four potential class types. The four potential classes commonly showed the same categorization results ？ the low-frequency religion-focused group, the low-frequency friendship-oriented group, and the high-frequency complex activity group. In addition, the married older people were classified into a high-frequency social-religious group, and the unmarried seniors were further classified into a low-frequency leisure-oriented group. The married older adults had the highest depression in the high-frequency complex activity group and the lowest in the high-frequency social/religious group. In contrast, the unmarried older adults showed the most increased depression in the low-frequency religious center group and the lowest depression in the high-frequency complex activity group. The results of this study show that the types of social participation of the older adults differ according to the presence or absence of a spouse and that the relationship with depression is also different for each type of social participation of the older adults.
  
  

• 10."Timing of Early Childcare use and Child Development: A Quantile Regression," Kang, Ji Young, Chungnam National University; Jeon, Gyeahyung, Hannam University
  
  This study examined the effect of the timing of usage of early childcare on children’s development using Panel Study of Korean Children from the 1st to 7th waves. Applying a quanitle regression, we compared the distribution of internalizing, externalizing problem, receptive vocabulary score, and school readiness between children who entered early childcare at their early age of 1-2 and children who entered early childcare at the age of 4. The study found that when the risk of problem behavior is higher in the distribution of risk behaviors among children, the earlier the childcare service is used, the higher the possibility of internalization and externalization problems. However, even in high-risk children, problem behaviors do not persist for a long time. Second, in terms of school readiness, children in the lower decile (20-30th percentile) who used childcare services early had higher communication scores than the group who used childcare facilities from 2012 onwards. Third, as a result of examining the effect of the time of childcare service use for children of low-educated parents, it was found that the early use of childcare service had no statistically significant effect on the school readiness. Based on this, we propose policy support for high-risk children such as program interventions tailored to the child's propensity and childcare services for the vulnerable, low-educated households.
  
  

• 11."Introduction of Child Maltreatment Fatality Review to the Korean Child Protective System," Jung, Sun Wook, Duksung Women's University; Kang, Ji Young, Sookmyung Women's University; Kim, Jin Sook, Hanyang Cyber University; Lee, Se Won, Gangneung-Wonju National University; Jung, Sun Young, Incheon National University
  
  The purpose of this study is to 1) examine child maltreatment(CM) fatality review systems, a kind of child death review(CDR) relating to child maltreatment, in foreign countries, 2) inform lessons learned from foreign cases to the impending Korean CM fatality system, and 3) support establishment and implementation of the Korean system. For this, we selected five countries: the US (Texas), England, Scotland, Japan, and Taiwan. We examined the characteristics of CM fatality review systems of the five countries in the areas of planning, implementation, and outcomes based on the framework derived from ‘Quality Marker’. The findings suggest the following for the introduction of the Korean CM fatality review system. First, the central government needs to initiate and take the responsibility for CM fatality review at the early stage and then involve local governments to establish a two-tier system. Second, the CM fatality review system needs to be expanded to cover all child deaths. Third, the goal of the CM fatality review needs to be in the improvement of the child protective system and the environment surrounding children and families. Fourth, the legal groundwork needs to be established concerning CM fatality review procedure, parallel process with other reviews, and release of the CM fatality review report.
  
  

• 12."Factors Related to University Students' COVID-19 Vaccination Behavior: With a Focus on One University in Chungchoengnam-do," Baek, Min Ah, Soonchunhyang University; Kang, Eun Jeong, Soonchunhyang University; Ham, Young Eun, Hyosan Environment and Health Foundation; Yoo, Gi Min, Soonchunhyang University; Joo, So Yeon, Soonchunghyang University; Choi, Ji won, Soonchunhyang University
  
  The aim of this study was to identify the factors of university student group’s behavior regarding COVID-19 vaccination. The independent variables consisted of sociodemographic characteristics, health beliefs regarding COVID-19, knowledge on COVID-19, as well as health lifestyle and habits (smoking and drinking). A questionnaire was prepared through review of previous studies to proceed with the study, which was responded by 565 respondents. Stata version 16.0 was used for data analysis. Key findings are as follows. The student’s year of study and college as sociodemographic characteristics affected vaccination, and health belief factors such as perceived barrier and self-efficacy affected vaccination. Furthermore, among the healthy living risk factors, tobacco use affected vaccination. Based on these findings, suggestions were proposed to increase vaccination rates such as need for follow-up studies to know the difference in vaccination, the necessity for opening mandatory college classes on infectious diseases, and need for national intervention to verify the safety of vaccines.
  
  

• 13."Unmet Needs among Patients with Hypertension or Diabetes during the COVID-19 Pandemic by Household Income," Song, Eunsol, KIHASA; Park, Eunja, KIHASA; Choi, Seul Ki, University of Seoul
  
  COVID-19 pandemic has continued in South Korea for over two years since 2020. This study aimed to examine the prevalence of unmet healthcare needs among patients with hypertension or diabetes during the COVID-19 pandemic and to analyze the relationship between unmet healthcare needs and household income. We examined the unmet needs of 382 patients with hypertension or diabetes aged 19 or older using a telephone survey conducted in August 2021. About 17.8% of patients experienced unmet healthcare needs during the previous year. Moreover, 5.0 % answered that they did not use medical services due to the economic burden of medical service use. Logistic regression results showed that patients with a low household income had a significantly higher probability of unmet needs experience than those with high household income(OR: 4.95, 95% CI 1.91-12.87). Decreased household income during the COVID-19 pandemic also influenced the unmet needs in healthcare(OR: 2.24, 95%CI 1.23-4.07). These results indicate that policy intervention considering various causes of unmet needs is required to decrease unmet healthcare needs during the COVID-19 pandemic.
  
  

• 14."The Psychological Mechanism of Ageism among Korean Young and Middle Aged Adults: Age-based Social Identity and Aging Anxiety," Bae, Suhyun, Chung-Ang University; Kim, Giyeon, Chung-Ang University
  
  The purpose of the present study was to examine the effect of age-based social identity and aging anxiety on ageism among Korean young and middle aged adults. The participants were young aged adults form 20 to 29 years (N=136) and middle aged adults from 50 to 64 years of age (N=158). Results from hierarchial multiple moderating regression analysis were as follows. First, the test of interaction showed that age group moderated the relationship between age-based social identity and ageism. The test of a conditional effect of age group showed that young aged adults who reported lower levels and middle age adults who reported higher levels of age-based social identity were associated with greater ageism. Third, the results from test of interaction showed that age group moderated the relationship between aging anxiety and ageism. The results from test of a conditional effect of age group showed that young and middle aged adults who reported greater aging anxiety were associated with greater ageism. These findings suggest that the cause of generational conflict in Korea is the difference in values and mechanisms for ageism among young and middle aged adults.
  
  

• 15."A Study on the Policy Simulation Using Welfare Accounts from the Perspective of SNA," Noh, Yong-Hwan, Seoul Women's University
  
  This study examines the significance of constructing welfare accounts which, while consistent with the System of National Accounts (SNA), can complement the limitations of the OECD Social Expenditure Statistics (SOCX) in analyzing the economic effects of welfare policies, and proposes a simulation method using such welfare accounts. The net effect of welfare expenditure by function on household income and distribution was analyzed through multiplier analysis of the ‘social account matrix’ (SAM) that reflects the income flow of the real economy. Since the welfare account that can identify administrative expenses as a policy vector was used, the net policy effect of welfare expenditure could be analyzed. The marginal propensity to consume was estimated by using data from the Household Financial Welfare Survey. Also, the consumption effect of welfare expenditure by household income decile was analyzed. Through the proposal of a simulation method using the welfare account, it is confirmed that the differences in welfare expenditure by function and the form of expenditure (such as cash, in kind, and administrative expenses) cause differences in income distribution and also affect the consumption welfare by income decile. It is expected that the simulation method proposed through this study will play a new role that has not been previously proposed before in finding appropriate welfare policies for each economic activity and household sector.
  
  

• 16."Factors Influencing the Attitudes toward the Advanced Directives of Patients with Cancer: Focusing on the Psychological, Family, and Social Aspects," Jin, Yujeong, Ewha Womans University; Chun, JongSerl, Ewha Womans University
  
  This study aimed to contribute to the dignified death of patients with cancer by investigating psychological, family, and social factors affecting patients’ advanced directives(AD). From March to September 2021, a face-to-face survey was conducted on 182 adult cancer patients aged 19 or older in a general hospital in Gyeonggi-do, and a hierarchical regression analysis was conducted. As a result, the family function showed a significantly positive correlation with AD(β=.280, p<.01). Through analysis including sub-areas of major variables, the lower the anxiety regarding loss of existence(β=-.332, p<.001) among the sub-areas of death anxiety, the higher the support of medical personnel(β=.179, p<.01) among the sub-areas of social support, and the higher the family adaptability(β=.347, p<.05) among the sub-areas of family function, the more positive the attitudes were toward AD. This suggested that the supportive approach of medical personnel and experts and the evaluation of family dynamics are important, along with mitigating death anxiety through the assignment of subjectivity to patients in the AD process. The results of this study can be used as a theoretical basis for activating AD for patients with the No. 1 cause of death in Korea.
  
  

• 17."Leading Policy Acts Detection and COVID-19 Countermeasure Legislation's Impact Evaluation: Legal Code Citation Network Analysis on the Health and Welfare Policies," Kim, Ikdu, ROK National Assembly; An, Eunseong, Korea Health Promotion Institute
  
  Through the legal code citation network analysis, we categorized the leading policy acts from the Korean health and welfare laws, provided the future legislative plans, and confirmed the COVID-19 Countermeasure legislation’s impact on the structure of the laws. We found that the high statutes are evenly reflected in each policy area and overall matched to the Ministry of Health and Welfare organization. In line with the results of previous studies, we identified through the Louvain method that the legislation is clustered around each policy area. Furthermore, we evaluated the COVID-19 countermeasure legislation’s impact as limited because the acts were only influential in related laws.
  
  

• 18."A Study on Factors of Care Resources Use among the Korean Elderly," Lee, Sang-Woo, Mokwon University
  
  This study aimed to analyze factors of care resources use among the elderly. Data from the Survey of Living Conditions and Welfare Needs of the Elderly in Korea (for years 2008, 2014 and 2020) were analyzed by logistic regression and multi-level analysis. A key finding was that informal care resources like family members were still playing an important role at every survey. The proportion of formal care resources such as long-term care services increased with time. However, this was not associated with decrease in the burden of family members. Second, the characteristics of the elderly who use formal care resources were elderly women, the oldest-old, the low-educated elderly, and the low-income elderly. Also, alogistic regression and multi-level analysis found that factors such as whether living alone were significantly associated with formal care resources in all time points, but the odds ratio decreased with time. On the other hands, physical and cognitive functions (activities of daily living (ADL) and dementia), long-term care grade had a statistically significant effect on care resources use among the elderly. These results mean that the expansion of the formal care service had a significant effect over recent years. Implications on formal care resources of Korea were discussed based on the findings.
  
  

• 19."Examining the Effect of Health Status on Changes in Life Satisfaction in Older Adults," Wang, Juanjuan, Keimyung University; Hoe, Maanse, Keimyung University; Kim, Youngsook, Namseoul University
  
  Life satisfaction is a key indicator of subjective well-being, and an important quality-of-life indicator in gerontology. In this paper, we use Korean welfare panel data for the years from 2017 to 2020 (N=5810) to examine the trajectory of life satisfaction over time and understand how older adults' health status affects the trajectory of life satisfaction. The Latent Growth Curve Model (LGCM) was used and main results are as follows. First, the life satisfaction of older adults showed a non-linear (quadratic) change over the study period. Specifically, life satisfaction showed a slight increase and then a slight decrease over time. Second, depression, self-esteem, and self-rated health significantly affect change in life satisfaction in older adults. In other words, older adults with low levels of depression and high levels of self-esteem and self-rated health had higher levels of life satisfaction. In this regard, more programs and social welfare services should be implemented to enable older adults to reduce depression, increase self-esteem, and improve self-rated health, thereby increasing their life satisfaction.
  
  

• 20."Changes in Emergency Medical Services Utilization Before and After COVID-19: Focused on General Hospitals and Higher-Tier Medical Institutions," Kim, Jungju, Ministry of Health; Kim, Sangmi, Jeonju University; Shin, Donggyo, National Health Insurance Service Ilsan Hospital
  
  This study examined to what extend the outbreak of Covid-19 influenced emergency medical service utilization. Changes in medical services utilization were analyzed using monthly data for the years 2018 to 2020 from the Health Insurance Review and Assessment Service. Percentage analysis was conducted on changes in medical use before and after COVID-19, and the difference in usage between perids 2018-2019 and 2019-2020 was analyzed by linear regression. Changes in the trend of emergency medical services used due to the COVID-19 outbreak were analyzed using local weighted regression method. In 2020, the utilization of emergency medical services at general hospitals or higher-tier medical institutions decreased by 22.8% compared to the average before the COVID-19 outbreak, and the number of patients decreased significantly during the first, second, and third waves of the COVID-19 pandemic. Specifically, medical use declined more significantly among patients with mild conditions than among those with severe conditions. Meanwhile, the mortality rate within 7 days of visiting the emergency room increased by 32.6% after COVID-19, indicating that a decrease in emergency medical use led to a decrease in the performance of emergency care.