Journal of Pharmacopuncture (대한약침학회지)

KOREAN PHARMACOPUNCTURE INSTITUTE (대한약침학회)
권호 표지
DOI QR코드

DOI QR Code

National Health Insurance Data as a Research Tool in Korean Medicine: a guide to database utilization and methodological approaches

  • Chan-Young Kwon (Department of Oriental Neuropsychiatry, Dong-Eui University College of Korean Medicine) ;
  • Il-Su Park (Department of Healthcare Management, College of Nursing, Healthcare Sciences and Human Ecology, Dong-Eui University)
  • Received : 2024.12.19
  • Accepted : 2025.02.04
  • Published : 2025.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: This study aims to provide a practical framework for Korean medicine (KM) researchers on effectively utilizing Korean National Health Insurance (NHI) data, focusing on database characteristics, access methods, and methodological considerations for generating high-quality evidence in KM research. Methods: This study analyzed the NHI data system structure, analyzing its two major databases: the National Health Insurance Service (NHIS) and Health Insurance Review and Assessment Service (HIRA). We examined available data types, access protocols, and methodological approaches, with particular emphasis on their application in KM research. The study synthesized current challenges and opportunities specific to KM research using these databases. Results: Our analysis revealed three key findings: 1) The distinct characteristics and complementary nature of NHIS and HIRA databases, with NHIS providing comprehensive longitudinal data suitable for cohort studies and HIRA offering detailed cross-sectional data optimal for utilization pattern analysis; 2) Multiple data access options including Sample Research DB and Customized Research DB from NHIS, and Patient Sample Data and Customized Research Data from HIRA, each with specific advantages for different research designs; 3) Critical methodological considerations for KM research, particularly addressing the limited coverage of KM services (0.8% of total covered items) and the high proportion of non-covered services in KM practices (24.2-49.2% across different institution types). Conclusion: For effective utilization of NHI data in KM research, we recommend: 1) Implementing hybrid research designs that combine health insurance data with institutional data to overcome limited KM coverage; 2) Establishing clear operational definitions and applying appropriate statistical methods for bias adjustment; 3) Working toward developing a specialized Korean Medicine Utilization Cohort Database. These approaches can enhance the quality and generalizability of KM research using health insurance data, ultimately contributing to evidence-based practice in Korean medicine.

Keywords

References

  1. Seong SC, Kim YY, Khang YH, Park JH, Kang HJ, Lee H, et al. Data resource profile: the National Health Information Database of the National Health Insurance Service in South Korea. Int J Epidemiol. 2017;46(3):799-800.
  2. Kwon S. Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage. Health Policy Plan. 2009;24(1):63-71. https://doi.org/10.1093/heapol/czn037
  3. Lim B. Korean medicine coverage in the National Health Insurance in Korea: present situation and critical issues. Integr Med Res. 2013;2(3):81-8. https://doi.org/10.1016/j.imr.2013.06.004
  4. Kyoung DS, Kim HS. Understanding and utilizing claim data from the Korean National Health Insurance Service (NHIS) and Health Insurance Review & Assessment (HIRA) database for research. J Lipid Atheroscler. 2022;11(2):103-10. https://doi.org/10.12997/jla.2022.11.2.103
  5. Lee JA, Oh JH, Moon SJ, Lim JT, Lee JS, Lee JY, et al. Assessment of needs and accessibility towards health insurance claims data. Health Policy Manag. 2011;21(1):77-92. https://doi.org/10.4332/KJHPA.2011.21.1.077
  6. National Health Insurance Sharing Service. Status of big data provision to the private sector [Internet]. Wonju: National Health Insurance Service; 2022 Nov 30 [cited 2024 Sep 21]. Available from: https://nhiss.nhis.or.kr/lp/f/a/100/lpfa100m03.do
  7. Health Insurance Review and Assessment Service (HIRA). HIRA big data analysis educational material – introduce to HRA big data and support service [Internet]. Wonju: HIRA; 2022 Apr28 [cited 2024 Oct 22]. Available from: https://opendata.hira.or.kr/op/opb/selectRfrm.do?sno=13110&rfrmTpCd=&searchCnd=&searchWrd=%EB%B9%85%EB%8D%B0%EC%9D%B4%ED%84%B0&pageIndex=1
  8. Ryu DR. Introduction to the medical research using national health insurance claims database. Ewha Med J. 2017;40(2):66-70. https://doi.org/10.12771/emj.2017.40.2.66
  9. Lim HS, Oh HC, Jang JH, Yoon SL, Lee JK, Park SH, et al. Research on the development of an analysis method inspection tool to improve the quality of big data research using the national health information DB - a methodological review of studies utilizing the national health information DB [Internet]. Goyang: National Health Insurance Service Ilsan Hospital; 2021 Feb 5 [cited 2024 Jul 5]. Available from: https://repository.nhimc.or.kr/handle/2023.oak/185
  10. Kwon O. A normative study on health security governance system in Korea. Korean J Med Law. 2020;28(1):129-50. https://doi.org/10.17215/kaml.2020.06.28.1.129
  11. Son RH. National Health Insurance Service DB research support increased 12 times in 6 years [Internet]. Seoul: Medifonews; 2020 Jul 21 [cited 2024 Oct 22]. Available from: https://www.medifonews.com/news/article.html?no=154301
  12. National Health Insurance Sharing Service. 2024 First quarter health insurance big data utilization training [Internet]. Wonju: National Health Insurance Service; 2024 Mar 4 [cited 2024 Mar 4]. Available from: https://nhiss.nhis.or.kr/lp/j/c/002/lpjc002m01.do
  13. Lee D, Park M, Chang S, Ko H. Protecting and utilizing health and medical big data: policy perspectives from Korea. Healthc Inform Res. 2019;25(4):239-47. https://doi.org/10.4258/hir.2019.25.4.239
  14. Health Insurance Review and Assessment Service (HIRA). The HIRA ICT system, 2021 [Internet]. Wonju: HIRA; 2021 [cited 2024 Apr 4]. Available from: https://www.hira.or.kr/ra/ebook/list.do?pgmid=HIRAA030402000000
  15. Ministry of Health and Welfare (MOHW). The 1st national health insurance comprehensive plan (2019~2023) [Internet]. Sejong: MOHW; 2019 May [cited 2024 Oct 22]. Available from: https://www.mohw.go.kr/board.es?mid=a10401000000&bid=0008&act=view&list_no=349293&tag=&nPage=1
  16. Park EC, Jang SI. Assessment and improvement of health insurance claim disease code and medical record consistency [Internet]. Wonju: Health Insurance Review and Assessment Service, Seoul: Yonsei University; 2018 Jan 18 [cited 2024 Jun 22]. Available from: https://repository.hira.or.kr/handle/2019.oak/730
  17. Soni PD. Selection bias in population registry-based comparative effectiveness research. Int J Radiat Oncol Biol Phys. 2019;103(5):1058-60. https://doi.org/10.1016/j.ijrobp.2018.12.011
  18. National Health Insurance Sharing Service. Samle cohort 2.2 DB user manual (ver 1.3) [Internet]. Wonju: National Health Insurance Service; 2022 Apr [cited 2024 Sep 10]. Available from: https://nhiss.nhis.or.kr/lp/z/z/999/lpzzcms.do?cntsKeyVl=D
  19. Myeong RM, Hyeon DS, Lee YJ, Park YY, Yun JH, Kim GN, et al. 2022 Health insurance patient medical expense survey [Internet]. Wonju: National Health Insurance Service; 2024 May [cited 2024 Jun 10]. Available from: https://www.nhis.or.kr/nhis/together/wbhaec08200m01.do?mode=view&articleNo=10843726
  20. Kwon CY. Gap between the scientificization and utilization of Korean medicine for depressive disorder in South Korea with the highest suicide rate among OECD countries. J Clin Med. 2022;11(23):7022. https://doi.org/10.3390/jcm11237022
  21. Lee SY, Yoo JH, Seo SI, Lee JE, Kim GW, Cho E. The mental health outcomes and cost estimates of Korean medicine for anxiety disorder patients. Healthcare (Basel). 2024;12(13):1345. https://doi.org/10.3390/healthcare12131345
  22. Kwon CY, Shin S, Kwon OJ, Moon W, Kim N, Park M. National health insurance data analysis for the second-wave development of Korean medicine clinical practice guidelines in South Korea. J Pharmacopuncture. 2023;26(2):198-209. https://doi.org/10.3831/KPI.2023.26.2.198
  23. Lee JW, Hwang J, Hyun MK. Prevalence and treatment patterns of sleep disorders in the under 20 population: analysis using a national health insurance claims database. J Pharmacopuncture. 2022;25(3):276-89. https://doi.org/10.3831/KPI.2022.25.3.276
  24. Yang MY, Kim EJ, Nam D, Park Y, Ha IH, Kim D, et al. Trends of Korean medicine service utilization for lumbar disc herniation and spinal stenosis: a 10-year analysis of the 2010 to 2019 data. Medicine (Baltimore). 2024;103(30):e38989. https://doi.org/10.1097/MD.0000000000038989
  25. Statistics Korea. Domestic status, overview of official statistics by sector [Internet]. Daejeon: Statistics Korea; 2024 Oct 10 [cited 2024 Oct 10]. Available from: https://www.narastat.kr/pms/pub/scs/css/selectConfmStatsStatusRealm.do
  26. Kim SY, Lim YC, Seo BK, Nam D, Ha IH, Lee YS, et al. A study on the 10-year trend of surgeries performed for lumbar disc herniation and comparative analysis of prescribed opioid analgesics and hospitalization duration: 2010-2019 HIRA NPS Data. BMC Musculoskelet Disord. 2024;25(1):65. https://doi.org/10.1186/s12891-024-07167-w