• 약학회지
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• 제53권3호
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• pp.138-144
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• 2009

The purpose was to implement drug utilization review (DUR) for whom were diagnosed with chronic kidney disease (CKD) population using health insurance claim data. This study constructed drug utilization database using Health Insurance Review and Assessment Service (HIRA) database and selected contraindicated drugs with kidney based on previously developed drug utilization guide and reviewing other countries' examples. Main outcome measures were the proportion of prescription for 1 or more drugs of concern. The cohort included 115,948 subjects, who were diagnosed with chronic kidney disease. Inappropriate drugs with CKD patients was some used, and the most commonly prescribed classes were aluminum drugs. However it is difficult to find problems with inappropriate drug because claims data doesn't have laboratory data. Based on the result of retrospective drug utilization review study, more studies should be analysed drug utilization patterns and monitoring system should be developed.

• 한국병원경영학회지
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• 제28권3호
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• pp.47-57
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• 2023

Purpose: Health expenditure and utilization of Korean medicine are increasing every year. Since Chuna Manual Therapy was covered by National Health Insurance in 2019, it is predicted that the usage of Chuna Manual Therapy would be also increasing. However, there are few studies about Chuna Manual Therapy using Korean National Health Insurance claims database. Therefore, we will investigate the utilization trend of outpatient's Chuna Manual Therapy using Korean National Health Insurance database and suggest political implications. Methodology: The Korean National Health Insurance claims database was used to identify outpatient's Chuna Manual Therapy usage spanning 4 years from 2019-2023 and the number of Chuna Manual Therapy claims were approximately 18.61 million. Findings: The number of Chuna Manual Therapy claims and patients, health expenditure of Chuna Manual Therapy have been increasing spanning 4 years among over 65 aged. In the case of female patients, the number of Chuna Manual Therapy claims was more than male patients and health spending related to Chuna Manual Therapy was also higher than male patients. Most patients visited Korean medicine clinics due to musculoskeletal diseases, and most claims were from rural regions. Practical Implication: Since Chuna Manual Therapy was covered by National Health Insurance in 2019, Utilization of Chuna Manual Therapy has been increased overall. In particular, Chuna Manual Therapy is mostly implemented in the elderly, Korean medicine clinics, and local areas, thus policy managers will need to consider this.

• Journal of Preventive Medicine and Public Health
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• 제57권1호
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• pp.1-7
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• 2024

Objectives: Adjusting for potential confounders is crucial for producing valuable evidence in outcome studies. Although numerous studies have been published using the Korea National Health Insurance Claim Database, no study has critically reviewed the methods used to adjust for confounders. This study aimed to review these studies and suggest methods and applications to adjust for confounders. Methods: We conducted a literature search of electronic databases, including PubMed and Embase, from January 1, 2021 to December 31, 2022. In total, 278 studies were retrieved. Eligibility criteria were published in English and outcome studies. A literature search and article screening were independently performed by 2 authors and finally, 173 of 278 studies were included. Results: Thirty-nine studies used matching at the study design stage, and 171 adjusted for confounders using regression analysis or propensity scores at the analysis stage. Of these, 125 conducted regression analyses based on the study questions. Propensity score matching was the most common method involving propensity scores. A total of 171 studies included age and/or sex as confounders. Comorbidities and healthcare utilization, including medications and procedures, were used as confounders in 146 and 82 studies, respectively. Conclusions: This is the first review to address the methods and applications used to adjust for confounders in recently published studies. Our results indicate that all studies adjusted for confounders with appropriate study designs and statistical methodologies; however, a thorough understanding and careful application of confounding variables are required to avoid erroneous results.

• 한국병원경영학회지
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• 제28권1호
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• pp.24-36
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• 2023

Purposes: The purpose of this study was to analyze the factors associated with current smoking status in Wonju-si and Chuncheon-si, and to study the cause of difference in smoking rates between these two regions. Methodology: Data was from the National Health Insurance Service database from 2019 to 2020. Current smoking status was based on the response to the health examination questionnaire. Logistic regression analysis was conducted to identify factors associated with current smoking status. The study included 207,307 individuals from Wonju-si and 173,698 individuals from Chuncheon-si. Findings: The smoking rate of Wonju-si was 19.83%, and Chuncheon-si was 18.20%, showing a difference in the smoking rates between the two regions. Logistic regression analysis found that men, those aged 40-49, being a self-employed insured, a medical-aid beneficiary, having a lower income, working in construction, transport, storage, communication, or manufacturing industries, having a high-risk drinking level and being underweight were significantly associated with a higher likelihood of smoking(p<0.05). Additionally, having a chronic disease was associated with a lower likelihood of smoking in the case of Chuncheon-si(p<0.05). Practical Implication: This study found the differences of factors associated with smoking rates between the two regions and could provide implications for establishing intervention programs or policies that could contribute to lowering the smoking rate in areas with high smoking rates.

• 보건행정학회지
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• 제23권2호
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• pp.152-161
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• 2013

Korea has a single National Health Insurance program and all citizens are covered under this program, accounting 97% of the population, approximately 50 million people. Claims submitted by Health care providers are reviewed by Health Insurance Review and Assessment (HIRA) for the reimbursement. HIRA database contains not only individual beneficiary's information, but also healthcare service information such as diagnosis, procedures, prescriptions and tests for them. HRA database has gained attention as importance source for research due to its rich healthcare information and the demand of HIRA database has increased. Due to its tremendous size, however, researchers have had problems in accessing the database to conduct research. To meet this demand, we conducted a study to develop the inpatient sample data from HIRA database for research. This study has two purposes: 1) to determine a needed sample size; 2) to test reliability and validity of the sample data. We determined an adequate sample size to ensure representativeness and generality with additional consideration for convenience of calculation. The minimum sample size was 729,904 for the generality, and 488,861 for representativeness. After considering the convenience of calculation, our final sample size was 13% of the population, which was about 7.7 million beneficiaries. Age (5 years interval) and gender were used as stratification variables for sampling. In order to examine whether this sample data appropriately reflect population, we tested the reliability and validity of the sample data. From the sample data, we computed average expenditure of total claims per inpatient for 2011, frequency of top 30 disease, estimation of the number of stroke patients from the sample data, and then compared them to those from the population. Results confirmed reliability and validity of the sample data.

• 보건행정학회지
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• 제19권4호
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• pp.53-65
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• 2009

Purpose: This study was conducted to identify the prenatal heath care utilization and expenditure among pregnant women. Method: This was a 5-month follow-up study using a stratified sampling and the data were drawn from the "nationwide claim database of Korean National Health Insurance Corporation". Result: This study found that pregnant women were first diagnosed with pregnancy when they were 7.1 weeks pregnant, received 12.7 times of prenatal examinations and 10.6 times of ultrasonogram. It was revealed that 67.5% of the subjects continued to receive prenatal care at the same medical institutions from the diagnosis of pregnancy to the delivery. The study also showed that the total expenditure of prenatal care per pregnant woman was 700,000 Korean Won (KRW) on average and the insurance coverage rate stood at only 20%. Pregnant women living in metropolitan area spent more on prenatal healthcare expenditure than those who living in medium-sized city or rural area. Conclusion: The results of this study implies that the government needs to provide pregnant women with continuous support by increasing health insurance coverage for prenatal care. Especially, it is considered to provide more support to the pregnant women residing in medically underserved areas.

• Journal of Korean Medical Science
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• 제33권44호
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• pp.276.1-276.10
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• 2018

Background: The National Health Insurance Service (NHIS) established a healthcare claim database for all Korean citizens. This study aimed to analyze the NHIS data and investigate the patterns of breast cancer treatments. Methods: We constructed a retrospective female breast cancer cohort by analyzing annual incident cases. The annual number of newly diagnosed female breast cancer was compared between the NHIS data and Korea National Cancer Incidence Database (KNCIDB). The annual treatment patterns including surgery, chemotherapy, radiation therapy, endocrine therapy and targeted therapy were analyzed. Results: A total of 148,322 women with newly diagnosed invasive breast cancer during 2006-2014 was identified. The numbers of newly diagnosed invasive breast cancer cases were similar between the NHIS data and KNCIDB, which demonstrated a strong correlation (r = 0.995; P < 0.001). The age distribution of the breast cancer cases in the NHIS data and KNCIDB also showed a strong correlation (r = 1.000; P < 0.001). About 85% of newly diagnosed breast cancer patients underwent operations. Although the proportions of chemotherapy use have not changed during 2006-2014, the total number of chemotherapy prescriptions sharply increased during this period. The proportions of radiotherapy and anti-hormonal therapy increased. Among the anti-hormonal agents, tamoxifen was the most frequently prescribed medication, and letrozole was the most preferred endocrine treatment in patients aged ${\geq}50$ years. Conclusion: Along with the increased breast cancer incidence in Korea, the frequencies of breast cancer treatments have increased. The NHIS data can be a feasible data source for future research.

• 보건행정학회지
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• 제30권4호
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• pp.460-466
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• 2020

Background: The purpose of this study is to analyze whether there is a change in patterns of medical use among those likely to be converted their health insurance qualifications when the family support rule is alleviated. There is no empirical analysis that converting health insurance qualification will affect the increase in medical use. Methods: For analysis, data were extracted from the national health insurance eligibility and medical care database. To identify analysis targets similar to that of medical aids' characteristics among health insurance coverage, we compared income, property level, and medical use patterns through basic statistical analysis and used a difference-in-difference (DID) analysis to estimate the net effect of changes in medical use following the change of qualifications. Results: The main results are as follows. The results show that those who are under the 5% income group (1st income group) of health insurance coverage are the most similar to the medical aids group. DID analysis shows that changes in the medical use of people who maintain their national insurance qualification and who are not. As a results, the number of hospitalized days of converting group was reduced by 3.5 days while outpatient days were increased by 1.8 days. Conclusion: As a result, there was not much difference in the patterns of medical use for the under 5% income group who are likely to be eligible for expanded medical aids when the family support rule is alleviated. In addition, more than 30% of them are in arrears with their health insurance premiums, causing inconvenience in using medical services. These findings suggest the need of abolishing the criteria obligated to support family, and great efforts should be made to contribute to non-paid poor and remove their medical blind spot.

• 응용통계연구
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• 제30권1호
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• pp.13-24
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• 2017

국민건강보험공단에서 제공하는 표본코호트DB는 보건의료계뿐만 아니라 통계학 연구를 위한 중요한 자원이다. 일반적으로 이들 자료에서 연구에 필요한 정보를 얻기 위하여 관련 사례들을 추출하는 과정에는 많은 시간과 노력이 들게 된다. 본 논문에서는 표본코호트DB를 이용하고자 할 때 사례 추출과정에 도움을 주는 데이터베이스 시스템인 National Health Insurance Service Cohort DB Extract Tool(NICE Tool)을 소개한다. SAS의 DATA 명령문이나 SQL문에 익숙하지 않은 연구자들도 쉽게 마우스 클릭만으로 DB에서 필요한 변수들과 조건에 맞는 사례들을 추출할 수 있는 기능을 제공한다. 이 시스템을 활용하면 빠른 사례추출이 가능하여 표본코호트DB를 사용한 연구들이 더욱 활성화되리라 판단된다.

• Safety and Health at Work
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• 제10권3호
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• pp.265-274
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• 2019

Background: Methyl alcohol poisoning in mobile phone-manufacturing factories during 2015-2016 was caused by methyl alcohol use for cleaning in computerized numerical control (CNC) processes. To determine whether there were health complications in other workers involved in similar processes, the Occupational Safety and Health Research Institute conducted a survey. Methods: We established a national active surveillance system by collaborating with the Ministry of Employment and Labor and National Health Insurance Service. Employment and national health insurance data were used. Overall, 12,048 employees of major domestic mobile phone companies and CNC process dispatch workers were surveyed from 2016 to 2017. We investigated methyl alcohol poisoning by using the national health insurance data. Questionnaires were used to investigate diseases due to methyl alcohol poisoning. Results: Overall, 24.9% of dispatched workers were employed in at least five companies, and 23.9% of dispatched workers had missing employment insurance history data. The prevalence of blindness including visual impairment, optic neuritis, visual disturbances, and alcohol toxicity in the study participants was higher than that reported in the national health insurance database (0.02%, 0.07%, 0.23%, and 0.03% versus 0.01%, 0.07%, 0.13%, and 0.01%, respectively, in 2015). Moreover, 430 suspicious workers were identified; 415 of these provided an address and phone number, of whom 48 responded (response rate, 11.6%). Among the 48 workers, 10 had diseases at the time of the survey, of whom 3 workers were believed to have diseases related to methyl alcohol exposure. Conclusion: This study revealed that active surveillance data can be used to assess health problems related to methyl alcohol poisoning in CNC processes and dispatch workers.