scholarly journals Medical service use and usual care of common shoulder disorders in Korea: a cross-sectional study using the Health Insurance Review and Assessment Service National Patient Sample

BMJ Open ◽  
2017 ◽  
Vol 7 (7) ◽  
pp. e015848 ◽  
Author(s):  
Hwansoo Joo ◽  
Yoon Jae Lee ◽  
Joon-Shik Shin ◽  
Jinho Lee ◽  
Me-riong Kim ◽  
...  
Keyword(s):  
Health Insurance ◽  
Usual Care ◽  
Service Use ◽  
Medical Service ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Patient Sample ◽  
National Patient ◽  
Shoulder Disorders

scholarly journals Analysis of medical services provided to patients with peripheral facial palsy in Korea: a descriptive, cross-sectional study of the health insurance review and assessment service national patient sample database

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Doori Kim ◽  
Boyoung Jung ◽  
Myoung-Ui Cho ◽  
Seong-Bae Song ◽  
Seol Hee Chung ◽  
...  
Keyword(s):  
Health Insurance ◽  
Facial Palsy ◽  
Service Use ◽  
Healthcare Services ◽  
Sociodemographic Factors ◽  
Medical Services ◽  
Cross Sectional ◽  
Patient Sample ◽  
Peripheral Facial Palsy ◽  
National Patient

Abstract Background This cross-sectional, retrospective, observational study analyzed the demographics of patients with peripheral facial palsy in South Korea and their use of healthcare services. Methods The 2016 Korean Health Insurance Review and Assessment National Patient Sample dataset was used; a total of 4790 patients, diagnosed with facial palsy, who had used healthcare services at least once between January 2016 and December 2016 were included, and data on the use of medical services, hospitalizations, sociodemographic factors, treatments, and medications were analyzed. Results Overall, 326 patients per 100,000 individuals used healthcare services at least once because of peripheral facial palsy in 2016, with higher numbers for women and those aged 50–59 years. The percentage of patients who used Korean traditional medicine (KM), Western medicine (WM), and both KM and WM was 54.4, 23.3, and 22.3%, respectively. Users of both WM and KM had higher per capita medical costs, more visits, and longer treatment durations. Physiotherapy was the most frequent WM treatment (44.4%), and “examinations” was the costliest (24.7%) category. “Procedures” was both the most frequent and costliest KM category (99.9 and 57.3%, respectively). “Continuous intravenous injections” (8.6%) and “superficial heat therapy” (8.3%) were the most frequent WM treatments, while acupuncture accounted for 98% of all KM treatments. Conclusions This study analyzed the demographic characteristics and medical service use of patients with peripheral facial palsy in detail. These results can be used as basic information to improve clinical and policy strategies for the management and treatment of peripheral facial palsy.

scholarly journals Analysis of medical services provided to patients with ankle sprains in Korea between 2015 and 2017: a cross-sectional study of the health insurance review and assessment service national patient sample database

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e039297
Author(s):  
Ho-sun Ryu ◽  
Boyoung Jung ◽  
Jiyoon Yeo ◽  
Jae-Hong Kim ◽  
Dongwoo Nam ◽  
...  
Keyword(s):  
Health Insurance ◽  
South Korea ◽  
Service Use ◽  
Medical Services ◽  
Secondary Outcome ◽  
Ankle Sprains ◽  
Future Health ◽  
Cross Sectional ◽  
Patient Sample ◽  
National Patient

ObjectivesTo provide useful information for policy-makers and clinicians by analysing the medical service use—divided into Western medicine (WM) and Korean medicine (KM)—of patients with ankle sprains in South Korea between 2015 and 2017.DesignCross-sectional, retrospective, observational study.SettingTertiary hospitals, WM hospitals, WM clinics, KM hospitals, KM clinics and others in South Korea.ParticipantsWe analysed claim data and patient information from the 2015 to 2017 Health Insurance Review and Assessment National Patient Sample (HIRA-NPS) dataset, including 151 415 patients diagnosed with a ‘dislocation, sprain and strain of joints and ligaments at ankle and foot level’ (10th revision of the International Statistical Classification of Diseases code S93) who used medical services at least once in 3 years between January 2015 and December 2017 in South Korea.Primary and secondary outcome measuresCost of medical care, number of consultations, type of institution visited, types of treatment.ResultsThere were 160 200 consultations and 53 044 patients in 2015, 149 956 consultations and 50 830 patients in 2016 and 140 651 consultations and 47 541 patients in 2017. The total treatment costs were US$3 355 044.21, US$3 245 827.70 and US$3 128 938.46 in 2015, 2016 and 2017, respectively. The most common age was 10–19 years. The most frequent type of visit was KM outpatient visit (56%). Physiotherapy was most common in WM outpatient visits, while acupuncture was most common in KM visits. Most patients used one institution, rather than alternating between WM and KM.ConclusionsBy identifying the trends and costs of treatment methods used for ankle sprains and comparing WM and KM, our data provide basic information for future health policy-making. In addition, the duality of the Korean medical system is highlighted as a possible cause of increased costs.

scholarly journals Prevalence of gout and asymptomatic hyperuricemia in the pediatric population: a cross-sectional study of a Japanese health insurance database

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shuichi Ito ◽  
Tomoko Torii ◽  
Akihiro Nakajima ◽  
Takeshi Iijima ◽  
Hiroshi Murano ◽  
...  
Keyword(s):  
Uric Acid ◽  
Health Insurance ◽  
Pediatric Population ◽  
Gouty Arthritis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Insurance Claims ◽  
Cross Sectional ◽  
Total Prevalence ◽  
Health Insurance Claims

Abstract Background Although gout is rare in children, chronic sustained hyperuricemia can lead to monosodium urate deposits progressing to gout, just as in adults. This study assessed prevalence and characteristics of gout and asymptomatic hyperuricemia, and incidence of gouty arthritis in the pediatric population, using data from Japanese health insurance claims. The diagnosis and treatment of pediatric gout and hyperuricemia were analyzed, and specific characteristics of those patients were assessed. Since Japanese guidelines recommend treatment with uric acid lowering drugs for asymptomatic hyperuricemia as well as for gout, these data were also used to investigate the real-world use of uric acid lowering drugs in a pediatric population. Methods This cross-sectional study was based on a 2016–2017 Japanese health insurance claims database, one of the largest epidemiology claims databases available in Japan, which included 356,790 males and 339,487 females 0–18 years of age. Outcomes were measured for prevalence, patient characteristics, treatment with uric acid lowering drugs for gout and asymptomatic hyperuricemia, and prevalence and incidence of gouty arthritis. Because uric acid can be elevated by some forms of chemotherapy, data from patients under treatment for malignancies were excluded from consideration. Results Total prevalence of gout and asymptomatic hyperuricemia in 0–18 year-olds was 0.040% (276/696,277 patients), with gout prevalence at 0.007% (48/696,277) and asymptomatic hyperuricemia at 0.033% (228/696,277). Prevalence of gout and asymptomatic hyperuricemia was highest in adolescent males, at 0.135% (176/130,823). The most common comorbidities for gout and asymptomatic hyperuricemia were metabolic syndrome at 42.8% (118/276) and kidney disease at 34.8% (96/276). Of the patients diagnosed with gout or asymptomatic hyperuricemia, 35.1% (97/276) were treated with uric acid lowering drugs. Gouty arthritis developed in 43.8% (21/48) of gout patients during the study, at an incidence of 0.65 flares/person-year. Conclusions Even the pediatric population could be affected by asymptomatic hyperuricemia, gout, and gouty arthritis, and uric acid lowering drugs are being used in this population even though those drugs have not been approved for pediatric indications. Such off-label use may indicate a potential need for therapeutic agents in this population. Trial registration UMIN000036029.

scholarly journals Evaluation of use and cost of medical care of common lumbar disorders in Korea: cross-sectional study of Korean Health Insurance Review and Assessment Service National Patient Sample data

BMJ Open ◽  
2016 ◽  
Vol 6 (9) ◽  
pp. e012432 ◽  
Author(s):  
Yong-Jun Ahn ◽  
Joon-Shik Shin ◽  
Jinho Lee ◽  
Yoon Jae Lee ◽  
Me-Riong Kim ◽  
...  
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Medication Cost ◽  
Billing Data ◽  
Cross Sectional ◽  
Patient Sample ◽  
Significant Difference ◽  
Sample Data ◽  
National Patient ◽  
Surgery Rates

ObjectivesTo assess medical care and costs of the 3 highest prevalence lumbar disorders—non-specific low back pain (nLBP), intervertebral disc disorder (IDD) and spinal stenosis (SS)—from national billing data to provide basic information for standards of appropriate management.DesignRetrospective analysis of National Health Insurance National Patient Sample data provided by the Korean Health Insurance Review and Assessment Service (HIRA).Setting2011 claims data from all medical institutions which filed billing statements to HIRA.ParticipantsA total of 135 561 patients with lumbar disorder who received medical services during 2011.Outcome measuresPatient characteristics, medical procedures, medication, cost, injection and surgery.ResultsIn the nLBP and IDD groups, the 50–59 age range had the highest prevalence, whereas prevalence increased with age in SS. All 3 groups showed a higher percentage in women. The average treatment cost was 196 552 KRW in the nLBP and 362 050 KRW in the IDD group, and highest in the SS group at 439 025 KRW. While in the nLBP group women spent more on medical expenses, in the other 2 groups men showed higher expenditure. Expenditure grew with age in the nLBP and SS groups, whereas that of the IDD group peaked in their 40s. Analgesics were used in 73.43% of patients with nLBP, 82.64% of patients with IDD and 86.46% of patients with SS, and opioids in 4.12% of patients with IDD and 5.36% of patients with SS. Surgery rates were highest in the SS group at 4.85%, with 0.9% for nLBP and 4.59% for IDD. The most frequent injection code was lumbar/caudal epidural nerve block. Expenditure and surgery rates were higher in the injection than in the non-injection subgroup in all 3 groups.ConclusionsPatterns of medical care of most frequent lumbar disorders from HIRA data showed significant difference between groups and provide a basic standard for future usual care guidelines linked with health policy and budget appropriation.

scholarly journals Degree of regional variation and effects of health insurance-related factors on the utilization of 24 diverse healthcare services - a cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wenjia Wei ◽  
Agne Ulyte ◽  
Oliver Gruebner ◽  
Viktor von Wyl ◽  
Holger Dressel ◽  
...  
Keyword(s):  
Health Insurance ◽  
Managed Care ◽  
Influencing Factors ◽  
Healthcare Utilization ◽  
Regional Variation ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Related Factors ◽  
Cross Sectional

Abstract Background Regional variation in healthcare utilization could reflect unequal access to care, which may lead to detrimental consequences to quality of care and costs. The aims of this study were to a) describe the degree of regional variation in utilization of 24 diverse healthcare services in eligible populations in Switzerland, and b) identify potential drivers, especially health insurance-related factors, and explore the consistency of their effects across the services. Methods We conducted a cross-sectional study using health insurance claims data for the year of 2014. The studied 24 healthcare services were predominantly outpatient services, ranging from screening to secondary prevention. For each service, a target population was identified based on applicable clinical recommendations, and outcome variable was the use of the service. Possible influencing factors included patients’ socio-demographics, health insurance-related and clinical characteristics. For each service, we performed a comprehensive methodological approach including small area variation analysis, spatial autocorrelation analysis, and multilevel multivariable modelling using 106 mobilité spaciale regions as the higher level. We further calculated the median odds ratio in model residuals to assess the unexplained regional variation. Results Unadjusted utilization rates varied considerably across the 24 healthcare services, ranging from 3.5% (osteoporosis screening) to 76.1% (recommended thyroid disease screening sequence). The effects of health insurance-related characteristics were mostly consistent. A higher annual deductible level was mostly associated with lower utilization. Supplementary insurance, supplementary hospital insurance and having chosen a managed care model were associated with higher utilization of most services. Managed care models showed a tendency towards more recommended care. After adjusting for multiple influencing factors, the unexplained regional variation was generally small across the 24 services, with all MORs below 1.5. Conclusions The observed utilization rates seemed suboptimal for many of the selected services. For all of them, the unexplained regional variation was relatively small. Our findings confirmed the importance and consistency of effects of health insurance-related factors, indicating that healthcare utilization might be further optimized through adjustment of insurance scheme designs. Our comprehensive approach aids in the identification of regional variation and influencing factors of healthcare services use in Switzerland as well as comparable settings worldwide.

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