• Korean Journal of Clinical Pharmacy
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• v.31 no.1
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• pp.35-43
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• 2021

Background: Migraine is a common neurological disorder that affects the quality of life and causes several health problems. Preventive migraine treatment can reduce migraine frequency, headache severity, and health care costs. This study aimed to estimate the utilization of migraine preventive therapy and associated factors in eligible patients. Methods: We studied 534 patients with migraine who were eligible for migraine preventive therapy using 2017 National Patient Sample (NPS) data from the Health Insurance Review and Assessment Service (HIRA). We estimated the migraine days by calculating the monthly average number of defined daily dose (DDD) of migraine-specific acute drug. Patients with a monthly average number of DDD of 4 or more were considered as subjects for preventive treatment. Chi-square test and multiple logistic regression analysis were used to determine the association between the preventive therapy and the influencing variables. Results: Less than half of the eligible patients for prophylaxis (n=234, 43.8%) were prescribed preventive therapy. Multiple logistic regression results show that migraine preventive therapy was influenced by age, the type of migraine, and some comorbidities. Patients over the age of 50 tend to receive less prophylactic treatment than under the age of 40. On the other hand, migraine patients with epilepsy or depression were more likely to receive preventive therapy. Sumatriptan was the most preferred medication for acute treatment, and propranolol was the most commonly prescribed drug for prevention. Conclusions: More than half of the patients who were candidates for migraine prophylaxis were not receiving suitable preventive treatment. Positive factors affecting the use of migraine prevention were the presence of comorbidities such as epilepsy and depression.

• The Journal of Korean Medicine
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• v.37 no.3
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• pp.112-122
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• 2016

Objectives: This study aimed to assess the validity of 'Korean Diagnosis Related Groups-Korean Medicine (KDRG-KM)' which was developed by Health Insurance Review & Assessment Service (HIRA) in 2013 Methods: Among inpatient EDI claim data issued by hospitals and clinics in 2012, the data which included Korean medicine procedures were selected and analyzed. We selected control targets in the Korean medicine hospitals which had longer Episodes-Costliness index (ECI) and Lengthiness index (LI) than average of total Korean medicine hospitals, and compared the results of selection between the major diagnosis-based patient classification system and the KDRG-KM system. Finally, the explanation power (R2) and coefficient of variation (CV) of the KDRG-KM system using practice expenses were calculated. Results: The numbers of control target in Korean medicine hospitals changed from 36 to 32 when patient grouping adjustment method was changed from major diagnosis to KDRG-KM. For expenses of all outpatient claim data on Korean medicine, explanation power of KDRG-KM system was 66.48% after excluding outliers. CVs of expenses of patient groups in Korean medicine hospitals were gathered from under 70% to under 90%, and those in long-term care hospitals mostly belonged under 70%. Conclusions: The validity of KDRG-KM system was assured in terms of explanation power. By adapting KDRG-KM system, fairness of control targets selection for costliness management in Korean medicine hospitals can be enhanced.

• Journal of the Korean Data and Information Science Society
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• v.28 no.1
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• pp.75-86
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• 2017

The facial palsy is one of the most common illness in Western-Korean collaborative treatment (hereinafter "collaborative treatment"). The purpose of this study is to analyze facial palsy patients'collaborative treatment use patterns. By analysing the 2014 National Health Insurance Review and Assessment Patient Sample Data (NPS 2014) with the episode of care unit, we have found the following results. First, the collaborative treatment is preferred by patients over 50 years old and female. Second, western medicine mainly focuses on diagnosis and medical examination while korean medicine and collaborative treatment focus more on treatment activity. Third, western medicine showed the shortest treatment period, followed by korean medicine and collaborative treatment. However, the cost of medical treatment per day is highest in western medicine. The analysis of the use patterns of collaborative treatment shown in the study is expected to provide a direction for the development of clinical practice guidelines and the establishment of medical policies in the future.

• Korea Journal of Hospital Management
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• v.18 no.1
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• pp.42-58
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• 2013

The purpose of this study was to investigate the awareness of long-term care hospitals on pay for performance(P4P) program in Korea. We conducted a cross-sectional, self-administered, the internet based survey from September to October in 2010. The questionnaire was consisted of the levels of awareness and agreement about the program, their preferred design and its possible effects and unintended consequences etc. Among 837 eligible long-term care hospitals in Korea, 114 hospitals(13.6%) were participated in the survey. About one-thirds of long-term care hospitals were not aware of P4P, namely it is important to heighten an awareness of P4P. There were pros and cons on introduction of P4P in Korea. The two major reasons of objections of P4P were the concerns of unintended consequences and the possibility of strengthening government control by implementing P4P. In conclusion, to successfully implement P4P to long-term care hospitals, the Health Insurance Review & Assessment Service(HIRA) in Korea should obtain the long-term care hospitals'opinion as to implementation of P4P.

• Journal of Oriental Neuropsychiatry
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• v.30 no.1
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• pp.31-38
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• 2019

Objectives: To identify the cost effectiveness of early dementia diagnosis using the 2014 Health Insurance Review & Assessment Service-National Patients Sample (HIRA-NPS). Methods: The medical costs of dementia between Western medical care and Korean medical care were compared through the reimbursement and non-reimbursement item code for dementia examination. In addition, the medical expenses of patients with dementia and mild cognitive impairment were compared and analyzed with respect to Western and Korean medical care. Results: There were 87,434 claims, of which 16,101 patients were diagnosed with dementia and 38,680,789,560 won was found to be the medical expenses. 12,881 patients (80.0%) with dementia, 3,144 patients (19.5%) with mild cognitive impairment, and 76 patients (0.5%) progressing from mild cognitive impairment to dementia. The proportion of medical expenses was 97.6% for dementia patients, 2.3% for mild cognitive impairment, and 1% for patients progressing from mild cognitive impairment to dementia. 86,070 claims (98.4%) were from Western medical care, with16,824 patients (98.2%), and the medical expenses was 38,546,895,400 won (99.7%). 1,361 claims (1.6%) were from Korean medical care, with 303 patients (1.8%), and the medical expenses was 133,894,160 won (0.3%). Conclusions: This study compared and analyzed the medical costs of dementia patients and the diagnosis of both Korean and Western medical care. The results of this study are expected to be used as basic research data for investigating cost effectiveness of developing early diagnosis of dementia.

• The Korean Society of Law and Medicine
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• v.18 no.2
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• pp.195-218
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• 2017

The increase in medical expenses for convalescent hospitals is increasing abnormally, which puts enormous burden on the National health insurance finances. This is a phenomenon that has been associated with the social phenomenon of rapid aging. The fact that the convalescent hospitals are paid the fixed amount per day for hospitalization became the incentive for some hospitals to use the patients as means of making money. And these hospitals intend to get regular care or take medicines at other hospitals in order to reduce medical expenses, even when the medical fee is paid. In order to prevent such financial leaks, the Health Insurance Review and Assessment Service adjusted the patient group for inpatients in a hospital with the above behavior, and then cut the cost of medical care benefits. However, Above decision was canceled by the court on the grounds that there was no basis rule. However, based on the above case, I think that it can be an opportunity to draw up the problem and to improve of the Medical Fee System of hospital. The modified medical fee system can strengthen the medical function of the convalescent hospital. In addition, it seems reasonable to exclude admission for "physically disabled group". Even if admission is allowed for the physically disabled group due to social needs, it should be excluded from the National health insurance for the fianacial soundness and the sustainability of the system.

• Korean Journal of Clinical Pharmacy
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• v.30 no.2
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• pp.81-86
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• 2020

Background: The number of patients with dementia continues to increase as the age of aging continues to grow. Psychiatric symptoms caused by senile dementia are controlled using antipsychotics. However, these antipsychotics can lead to Parkinson's disease, and abuse of dopamine derivatives such as levodopa among Parkinsonian drugs can lead to psychosis. Therefore, we evaluated the patterns of prescribed antipsychotics and antiparkinsonian drugs in patients with senile dementia. Methods: We used data from the sample of elderly patients from the Health Insurance Review and Assessment Service (HIRA-APS-2016). We analyzed the patterns of prescribing antipsychotics and antiparkinsonian drugs including prescribed daily dosage, period of prescription, and number of patients with both antipsychotics and antiparkinsonian drugs for senile dementia. Results: Among the 159,391 patients with dementia included in this analysis, 4,963 patients (3.1%) and 16,499 patients (10.4%) were prescribed typical and atypical antipsychotic drugs, respectively. The most frequently prescribed typical antipsychotic was haloperidol (4,351 patients with dementia), whereas the atypical agent was quetiapine (12,719 patients). The most frequently prescribed antiparkinsonian drugs were in the order of levodopa/carbidopa, benztropine, and ropinirole. In addition, 1,103 and 3,508 patients prescribed typical and atypical antipsychotics, respectively, were co-prescribed antiparkinsonian drugs. Conclusions: Atypical antipsychotics were the preferred prescription in patients with senile dementia. The prescription dose was relatively low; however, the average treatment duration was mostly long-term. Selection of antipsychotics and/or antiparkinsonian drugs should be made carefully in senile dementia and the causal relationship of adverse drug reactions needs further study.

• Knowledge Management Research
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• v.16 no.1
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• pp.209-224
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• 2015

Previous studies provided that limiting the number of services provided in hospital had influences in decreasing cost in delivering medical services. Hospitals could have positive effects on their profit by concentrating small number of services which they have comparative advantages. This study purposed to analyze the relationship between the concentration status of hospitals and medical charge for inpatients. National Inpatient sample data provided by the Health Insurance Review and Assessment Service (HIRA) for three years, 2009 to 2011 was used to compute the three concentration indices (Information Theory Index (ITI), Internal Herfindahl Index (IHI), and number of distinct Diagnosis-Related Groups (DRGs) treated) and total medical charge per inpatient case in each year. It was also used to select the control variables such as bed size, number of doctors per 100 beds, and locations. The ordinary least square regression models were developed and tested for hospital and general hospitals separately. The results showed that the total medical charge per inpatient case was significantly differed depending on the concentration indices, and there were positive relationships in ITI and IHI. The number of distinct DRGs had different directions in regression coefficients depending on the locations and hospital types. Hospitals had larger absolute standardized regression coefficients compare to those of general hospitals. However, their effects could be varied by the hospital types, number of doctors, and locations. It seems that hospitals have more influences on medical charges by concentrating their services than general hospitals. Study results provide knowledges to hospital administrators that concentration strategy can positive influences on the performance of small size hospitals.

• Korean Journal of Clinical Pharmacy
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• v.31 no.3
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• pp.198-204
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• 2021

Background: Cardiovascular (CV) disease is known as one of the major causes of death from disease worldwide. Statin therapy plays a pivotal role in atherosclerotic cardiovascular disease (ASCVD) lowering the LDL-cholesterol level effectively. The purpose of this study was to evaluate the association of the intensity of statin therapy in adult patients of Korea and the risk of ASCVD of the patient group. Methods: We used data from sample of patients from the Health Insurance Review and Assessment Service (HIRA-NPS-2018). We analyzed the patterns of prescribing statins including types of statin, statin intensity, and number of patients with ASCVD or risk of ASCVD. Results: 155,512 patients were included in the analysis, and 27,950 patients (18.0%) was over 75 years. High-intensity statin usage was increased in ASCVD patients compared with the low-intensity statin use. The OR (odds ratio) of high-intensity statin were increased in myocardial infarction patients compared with low-intensity statin use showing the highest OR; 12.40 (95% CI; 9.48-16.22). At patient groups of angina, ischemic heart disease and carotid disease, high-intensity statin prescription rate was increased compared with low-intensity statin. However, there was no statistical significance between both statin prescription rates in patients of peripheral arterial disease, abdominal aneurysm, diabetic mellitus and atherosclerosis. Conclusion: The statin prescription rate showed intensity increasing tendency according to the risk of ASCVD. More aggressive statin therapy might be beneficial for the ASCVD patients based on the recent guidelines of dyslipidemia.

• Korean Journal of Clinical Pharmacy
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• v.31 no.2
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• pp.153-159
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• 2021

Background: With increasing economic evaluation studies on the treatment of or screening tools for liver diseases that cause hepatocellular carcinoma (HCC), interest in the analysis of the medical utilization and costs of HCC treatment is increasing. Therefore, we aimed to estimate the medical utilization and costs of HCC patients, and calculate the cost of main procedures for HCC treatment, including liver transplant (LT), hepatic resection (HR), radiofrequency ablation (RFA), and transarterial chemoembolization (TACE). Methods: We analyzed claim data from January to December 2018 from the Health Insurance and Review and Assessment Service-National Patient Sample (HIRA-NPS-2018) dataset, including data of patients diagnosed with HCC (Korean Standard Classification of Diseases code C22.0) who had at least one inpatient claim for HCC. Results: A total of 715 HCC patients were identified. In 2018, the yearly average medical cost per HCC patient was ₩18,460K (thousand), of which ₩14,870K was attributed to HCC. Among the total medical costs of HCC patients, the inpatient cost accounted for the largest portion of both the total medical and HCC-related costs. The major procedures of HCC treatment occurred most frequently in the order of TACE, RFA, HR, and LT. The average medical cost per treatment episode was the highest for LT (₩87,280K), followed by HR (₩10,026K), TACE (₩4,047K), and RFA (₩2,927K). Conclusion: By identifying the medical costs of HCC patients and the costs of the main procedures of HCC treatment, our results provide basic information that could be utilized for cost estimation in liver disease-related economic evaluation studies.