Barcott-Kim Fellow, Ph.D. student Juyoung Kim focuses research on low-value care, global health policy

An experienced nurse and researcher of health care policy and finance is the newest Fellow in a University of Rhode Island College of Nursing program that aims to develop the next generation of nursing faculty members.

Juyoung Kim, a Ph.D. candidate from Daegu, South Korea, is the latest member of the Dr. Donna Schwartz-Barcott and Dr. Hesook Suzie Kim Nursing Fellowship. She plans to continue her research into value-based health care with the goal of expanding her research portfolio and one day teaching and researching at the collegiate level.

“I searched for information on value-based care and the expense of low-value health care, and I came across Professor Betty Rambur. She is quite devoted to that kind of research,” Kim said of the college’s Routhier Chair for Practice, an expert in health care policy and finance. “Then I found out about the Barcott-Kim Fellowship and thought this would be a great opportunity to join URI and to advance my academic career. Betty is the first reason I wanted to come here, but if not for this fellowship, I couldn’t make it because of tuition and added expenses. Those two things made me come here.”

Kim studied in her hometown of Daegu before moving to Seoul, where she worked for five years in a large hospital in post-surgery care, and with patients with pulmonary and infectious diseases. She then did her master’s work in public health policy at the University of Edinburgh in Scotland, before working in health policy back in South Korea.

“From that experience, I realized that I want to work on health policy, first in South Korea’s health system. Now I’m working on U.S. health policy,” Kim said. “Each country has a different health system and health insurance system. We have some similarities from the U.S. because the academic policies are imported from western countries, but also we have more of a European system. We have a different background, but research theories are common.”

One common research topic is the value of health care, and the ways to avoid treatments and screenings that offer low-value care, which can include services with high price tags, as well as unnecessary procedures. Specifically, Kim is working with Rambur on low-value care related to regular cervical cancer screenings, which the United States Preventative Taskforce recommends for women aged 21-65. However, many countries don’t perform routine screenings, and the costly exams may be over-prescribed in the U.S., a form of low-value care.

“People think that cancer screening is beneficial because it’s preventative care—and it can be—but in reality, the overprovision is overlooked. Everyone wants to prevent health risks, but it’s also related to money, so it’s quite tricky,” Kim said. “If there are reasons, it is reasonable to pay. But if there are no reasons, and it’s just for the relief of the patient without any benefits, it can be harmful. Preventive screenings can have harmful effects because they can lead to treatments that are sometimes unnecessary.”

The tendency to over-screen is a similarity the U.S. system has with South Korea, but not with many other countries, Kim said. As an example, she points to a minor back injury she suffered while studying in the U.K. When seeking treatment, she expected to be sent for x-rays or an MRI, as she likely would have in South Korea. Instead, a doctor simply performed a physical exam, then prescribed physical therapy and acetaminophen.

“I was shocked by that because I’m used to the South Korean system, and I thought they weren’t providing adequate services,” Kim said. “But I realized that maybe it’s enough with a physical examination, and looking at my history. Maybe prescribing an MRI was not necessary.”

These are lessons different health systems can learn from each other, an international experience Kim brings to her studies. Having that perspective is valuable in research, Rambur said, bringing a more well-rounded approach to the work.

“It is so exciting to see the reach of URI expand across the globe,” Rambur said about the university’s ability to attract international students like Kim. “I am so delighted to be working with Juyoung. She has extensive experience in health services research. We share a passion for addressing low value care and waste in the health care system.”

In addition to cost, the main problem in the U.S. system that most industrialized nations don’t have is access to care, Kim said. The for-profit, fee-for-service system largely controlled by powerful health insurance companies places barriers to care for a large swath of the population. The source of those barriers—of which there are several—and ways to overcome them in a budget-friendly way is the crux of Kim’s research.

“In the past, we didn’t think about the money so much; the focus was on the quality of the care,” Kim said. “Some health insurance companies and physicians are doing good things; some are not. We cannot just blame their characters. We should change the structure of the system. All over the world, health care costs are increasing because of health care advancement, longevity, etc., so we really need efficiency concepts, along with effectiveness.”

Kim will join Rambur in presenting their research at the Eastern Nursing Research Society annual conference April 3-4 in Philadelphia. She plans to continue her research while working toward her Ph.D., and ultimately share her experience and expertise with her future students

“With all the low-value health care, that’s why I am interested in this field. This research really intrigues me,” Kim said. “To provide the high-quality healthcare service for more people, this value concept is very important. Nurses are not always that familiar with this kind concept in health care. But we are key players in health care service, so I would like to provide my knowledge and experience to future nurses.”

Named for two former URI College of Nursing professors, the Barcott-Kim Fellowship will build the faculty pipeline by selecting and supporting registered nurses whose research interest stems from their area of practice. It is part of the College’s concerted effort to expand and enhance its capacity to impact health care, health education, and health research.

“The fellowship is important in so many ways. It will increase access to full-time study and address the nursing faculty shortage,” Schwartz-Barcott said. “These nursing scholars will be able to take insights from practice, generate and synthesize new knowledge and bring this back to the classroom and practice.”