The Korea National Disability Registration System.

The Korea National Disability Registration System (KNDRS) was established in 1989 to provide social welfare benefits based on predefined criteria for disability registration and an objective medical assessment using a disability grading system. Disability registration requires (1) a medical examination by a qualified specialist physician and (2) a medical advisory meeting to review the degree of disability. Medical institutions and specialists for the diagnosis of disabilities are legally stipulated, and medical records for a specified period are required to support the diagnosis. The number of disability types has gradually expanded, and 15 disability types have been legally defined. As of 2021, 2.645 million people were registered as disabled, accounting for approximately 5.1% of the total population. Among the 15 disability types, disabilities of the extremities account for the largest proportion (45.1%). Previous studies have investigated the epidemiology of disabilities using data from the KNDRS, combined predominantly with data from the National Health Insurance Research Database (NHIRD). Korea has a mandatory public health insurance system that covers the entire Korean population, and the National Health Insurance Services manages all eligibility information, including disability types and severity ratings. In short, the KNDRS-NHIRD is a significant data resource for research on the epidemiology of disabilities.

National practice patterns and direct medical costs for prostate cancer in Korea across a 10 year period: a nationwide population-based study using a national health insurance database.

BACKGROUND: A complete enumeration study was conducted to evaluate trends in national practice patterns and direct medical costs for prostate cancer (PCa) in Korea over a 10-year retrospective period using data from the Korean National Health Insurance Service. METHODS: Reimbursement records for 874,924 patients diagnosed between 2002 and 2014 with primary PCa according to the International Classification of Disease (ICD) 10th revision code C61 were accessed. To assess direct medical costs for patients newly diagnosed after 2005, data from 68,596 patients managed between January 2005 and 31 December 2014 were evaluated. RESULTS: From 2005 to 2014, the total number of PCa patients showed a 2.6-fold increase. Surgery and androgen deprivation therapy were the most common first-line treatment, alone or within the context of combined therapy. Surgery as a monotherapy was performed in 23.5% of patients in 2005, and in 39.4% of patients in 2014. From 2008, the rate of robot-assisted RP rose sharply, showing a similar rate to open RP in 2014. Average total treatment costs in the 12 months post-diagnosis were around 10 million Korean won. Average annual treatment costs thereafter were around 5 million Korean won. Out-of-pocket expenditure was highest in the first year post-diagnosis, and ranged from 12 to 17% thereafter. CONCLUSIONS: Between 2005 and 2014, a substantial change was observed in the national practice pattern for PCa in Korea. The present data provide a reliable overview of treatment patterns and medical costs for PCa in Korea.

Medical Travel among Non-Seoul Residents to Seek Prostate Cancer Treatment in Medical Facilities of Seoul.

PURPOSE: This study aims to investigate the trend in medical travel by non-Seoul residents to Seoul for treatment of prostate cancer and also to investigate the possible factors affecting the trend. MATERIALS AND METHODS: This study represents a retrospective cohort study using data from theKoreanNationalHealth Insurance System from 2002 to 2015. Annual trends were produced for proportions of patients who traveled according to the age group, economic status and types of treatment. Multiple logistic analysiswas used to determine factors affecting surgeries at medical facilities in Seoul among the non-Seoul residents. RESULTS: A total of 68,543 patients were defined as newly diagnosed prostate cancer cohorts from 2005 to 2014. The proportion of patients who traveled to Seoul for treatment, estimated from cases with prostate cancer-related claims, decreased slightly over 9 years (28.0 at 2005 and 27.0 at 2014, p=0.02). The average proportion of medical travelers seeking radical prostatectomy increased slightly but the increase was not statistically significant (43.1 at 2005 and 45.4 at 2014, p=0.26). Income level and performance ofrobot-assisted radical prostatectomy were significant positive factors for medical travel to medical facilities in Seoul. Combined comorbidity diseases and year undergoing surgery were significant negative factors for medical travel to medical facilities in Seoul. CONCLUSION: The general trend of patients travelling from outside Seoul for prostate cancer treatment decreased from 2005 to 2014. However, a large proportion of traveling remained irrespective of direct distance from Seoul.

Trend Analysis for the Choice and Cost of Lung Cancer Treatment in South Korea, 2003-2013.

PURPOSE: Our study aimed to report the annual changes in lung cancer statistics and analyze trends in sociodemographic, medical, and financial factors from 2003 to 2013 in the national database from the Korean National Health Insurance (KNHI). MATERIALS AND METHODS: Among 7,489 patients with code C34 in KNHI database, only lung cancer patients newly diagnosed after 2003 were included in the study population, for a total of 4,582 patients. Descriptive statistics were used to characterize treatment patterns and medical costs according to sociodemographic factors. RESULTS: Approximately 70% of subjects were male, and the mean age was 67 years. Around 46% of patients were over 70 years old, and 12% were over 80 years old. The medical costs were highest for patients younger than 60 and lowest for those over 80 years old. Surgery was more common in younger patients, while "no treatment" increased greatly with age. In trend analysis, the proportions of aging (p for trend < 0.001), female (p for trend=0.003), metropolitan/urban (p for trend=0.041), and lowest or highest-income patients (p for trend=0.004) increased over time, along with the prevalence of surgery as the primary treatment (p for trend < 0.001). There was also a trend with regard to change in medical costs (p for trend < 0.001), in that those of surgery and radiotherapy increased. CONCLUSION: Surgery as a curative treatment has increased over the past decade. However, the elderly, suburban/rural residents, and low-income patients were more likely to be untreated. Therefore, active measures are required for these increasingly vulnerable groups.

Expected and perceived efficacy of complementary and alternative medicine: A comparison views of patients with cancer and oncologists.

BACKGROUND & AIMS: This study sought to identify discrepancies between the expectations of patients with cancer and oncologists regarding the efficacy of complementary and alternative medicines (CAMs), and to determine how patients evaluate CAM efficacy after its use. METHODS: Data from the Cancer Patient Experience Study, a nationwide survey, were used. Seven subdivided efficacy domains were included in the survey. An oncologist-patient matching analysis was done to assess the concordance of CAM efficacies between oncologists and patients with cancer. In addition, the patients' expectations of CAM efficacies were compared before and after use. RESULTS: Out of 719 participants, 201 patients with cancer (28.0%) reported using CAMs. The patients with cancer generally tended to be more positive about CAM efficacies than the oncologists. The largest discrepancy in efficacy perception was found in the efficacy domain of survival benefit, which included complete disease remission and prolonged survival. Many patients reported that they did not experience the positive efficacy they had anticipated before use. However, a substantial proportion of patients indicated that CAMs were as effective as they had expected, even though there is little evidence supporting the CAM efficacies. CONCLUSIONS: There was a marked discrepancy and a lack of concordance in expectations of CAM efficacy between patients with cancer and oncologists. Better communication between the patients and oncologists regarding CAM efficacy would be needed to make the patients to have shared expectations, and to reduce unnecessary CAM use.

The economic burden of cancer in Korea in 2009.

BACKGROUND: Cancer imposes a significant economic burden on individuals, families and society. The purpose of this study was to estimate the economic burden of cancer using the healthcare claims and cancer registry data in Korea in 2009. MATERIALS AND METHODS: The economic burden of cancer was estimated using the prevalence data where patients were identified in the Korean Central Cancer Registry. We estimated the medical, non-medical, morbidity and mortality cost due to lost productivity. Medical costs were calculated using the healthcare claims data obtained from the Korean National Health Insurance (KNHI) Corporation. Non-medical costs included the cost of transportation to visit health providers, costs associated with caregiving for cancer patients, and costs for complementary and alternative medicine (CAM). Data acquired from the Korean National Statistics Office and Ministry of Labor were used to calculate the life expectancy at the time of death, age- and gender-specific wages on average, adjusted for unemployment and labor force participation rate. Sensitivity analysis was performed to derive the current value of foregone future earnings due to premature death, discounted at 3% and 5%. RESULTS: In 2009, estimated total economic cost of cancer amounted to $17.3 billion at a 3% discount rate. Medical care accounted for 28.3% of total costs, followed by non-medical (17.2%), morbidity (24.2%) and mortality (30.3%) costs. CONCLUSIONS: Given that the direct medical cost sharply increased over the last decade, we must strive to construct a sustainable health care system that provides better care while lowering the cost. In addition, a comprehensive cancer survivorship policy aimed at lower caregiving cost and higher rate of return to work has become more important than previously considered.

Factors associated with discontinuation of complementary and alternative medicine among Korean cancer patients.

OBJECTIVES: The purpose of this study was to determine patient characteristics and other factors associated with discontinuation of complementary and alternative medicine (CAM) among cancer patients in Korea. METHODS: A national, multicenter, cross-sectional survey of cancer patients was performed in which 674 of 2,661 patients were analyzed for their use of CAM after cancer diagnosis. Multiple logistic regression was used to identify the factors related to CAM discontinuation. RESULTS: Among the surveyed cancer patients, 25.3% (674 of 2,661) had used CAM, whereas 38.3% (258 of 674) of those with CAM experience had discontinued CAM therapy. The most frequently used form of CAM was herbs (43.5%). The major reasons for the discontinuation of CAM included absence of effects (23.9%), financial burden (22.9%), and physician opposition (13.7%). Other factors associated with the discontinuation of CAM included metastatic cancer (OR = 2.06), a long duration of cancer treatment (OR = 3.34), dissatisfaction (OR = 4.34), and side effects (OR = 4.23) of CAM therapy. CONCLUSIONS: For cancer patients to correctly employ CAM therapy, increase their satisfaction, and reduce their side effects, efforts should be made to analyze the cost effectiveness of CAM, and valid information must be provided to physicians and cancer patients.

Predictors of complementary and alternative medicine use in cancer care: results of a nationwide multicenter survey in Korea.

Background. Although studies have shown that the use of complementary and alternative medicine (CAM) is common in cancer patients, few surveys have assessed CAM use and associated factors in various cancers in Korea. Objectives. We explored factors predicting CAM use among a nationally representative sample of cancer patients. Methods. In total, 2,661 cancer patients were administered questionnaires about their CAM use and factors that might predict CAM use including sociodemographics, clinical and quality-of-life factors, time since diagnosis, trust in physicians, trust in hospitals, satisfaction, and informational needs. Data were analyzed using Pearson's χ(2) tests and multivariate logistic regression analysis. Results. Overall, 25.5% reported that they had used or were using CAM. Higher income, presence of metastasis, longer time since diagnosis, less trust in hospitals, lower overall satisfaction, and higher degree of informational need were significantly associated with CAM use. Conclusions. The use of CAM in patients with cancer can be interpreted as an attempt to explore all possible options, expression of an active coping style, or expression of unmet needs in the cancer care continuum. Physicians need to openly discuss the use of CAM with their patients and identify whether they have other unmet supportive needs.

Antihypertensive medication adherence in cancer survivors and its affecting factors: results of a Korean population-based study.

PURPOSE: Cancer survivors have been reported to receive less care for other conditions than the general population; however, it is not clear whether patients' behavior also contribute to this. The present study was performed to examine cancer survivors' adherence to antihypertensive medication and factors associated with it, compared to the general population. METHODS: We used pharmacy claims and enrollment data from the National Health Insurance, which covers 97% of the Korean population. In total, 2,455,193 subjects, including 12,636 (0.5%) cancer survivors, who were prescribed antihypertensive medications during the calendar year 2004 were identified. A cumulative medication adherence of 80% or above was defined as appropriate medication adherence. Two separate multiple logistic regressions were developed to compare the proportion of appropriate adherence between two populations and to identify factors affecting medication adherence in cancer survivors. RESULTS: Cancer survivors were less likely to have an appropriate medication adherence than the general population (adjusted odds ratio = 0.85; 95% CI, 0.82-0.88). Significant variation was observed in medication adherence according to cancer type. Several other factors, such as older age, low income, living in a rural area, and antihypertensive medication duration, also affected antihypertensive medication adherence. Contrary to the general population, younger survivors showed higher adherence. CONCLUSIONS: Clinicians involved in survivor care should check patient adherence to antihypertensive medication, as well as assess the possible reasons for nonadherence. Further studies are warranted to determine the reasons for nonadherence and to establish effective interventions in this vulnerable population.

Disparities between persons with and without disabilities in their participation rates in mass screening.

OBJECTIVES: The purpose of this study was to determine the number of persons with and without disabilities who participated in the National Health Insurance (NHI) chronic disease mass screening programs in South Korea. METHODS: The data were obtained from mass screening claims submitted to the NHI and National Disability Registry. Factors affecting the participation rate included demographic variables, socioeconomic status, residential region, and disability type and severity. A multiple logistic regression analysis was used to evaluate the relationship between participation rates and disability type and severity adjusted for confounding factors. RESULTS: The analysis revealed that persons with a disability were less likely to participate in mass screening programs than those without a disability (35.8% vs. 40.2%). Multiple logistic regression analysis indicated that persons with severe disabilities had lower participation rates than those without disabilities [adjusted odds ratio (aOR): 0.64, 95% confidence interval (CI): 0.63-0.64]. In particular, persons with severe disabilities such as limb, brain, visual and internal organ impairment, were less likely to participate in the mass screening programs. However, persons with mild disability had higher participation rates than those without disabilities (1.03, 1.02-1.03). CONCLUSIONS: Although the prevalence rates of chronic diseases are higher among persons with disabilities, various types of impairments such as limb, brain, visual and internal organ impairment, hinder participation in mass screening programs for chronic diseases. The reasons for this disparity must be investigated and health policies must be altered to make preventative treatments more accessible to persons with disabilities.

Disparities in antihypertensive medication adherence in persons with disabilities and without disabilities: results of a Korean population-based study.

OBJECTIVE: To determine disparities in antihypertensive medication adherence between persons with disabilities and those without disabilities in South Korea. DESIGN: The study compared antihypertensive medication adherence between persons with disabilities and those without disabilities using medical claims data of the National Health Insurance (NHI). SETTING: We obtained data from claims submitted to the NHI, which covers almost the entire Korean population. Persons who were prescribed antihypertensive medication during the calendar year 2004 were identified. PARTICIPANTS: The study comprised data from persons with disabilities (n=85,098) and persons without disabilities (n=2,368,636). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A cumulative medication adherence (CMA) greater than or equal to 80% was defined as an appropriate medication adherence. Multiple logistic regression was used to identify differences in antihypertensive medication adherence between persons with disabilities and without disabilities. Estimates were adjusted for demographic characteristics (sex, age), type of medical insurance, insurance contribution a month as a proxy for household income, residential area, and clinical characteristics (medication duration, comorbid conditions). RESULTS: People with disabilities had lower CMAs than those without (median CMA, 83.6% vs 85.7%; appropriate medication adherence, 54.5% vs 57.5%). Results of the multiple logistic regression adjusting other factors indicated that people with disabilities had decreased probabilities of appropriate adherence. CONCLUSIONS: Medication adherence is reduced by various types of disability and impairment such as those involving mobility and communication. Much effort should be made to investigate how and why these disparities take place and develop health policies to remove these disparities if they exist.

[Antihypertensive drug medication adherence of people with disabilities and its affecting factors in Korea].

OBJECTIVES: The aims of this study were to estimate the antihypertensive medication adherence in people with a disability and a history of taking antihypertensive medication, and to identify the factors affecting medication adherence. METHODS: The National Health Insurance claims data were linked with the National Disability Registry. People with a disability, who received a prescription of antihypertensives, were identified from a total of 85,098 cases. Cumulative medication adherence (CMA) was used as an indicator of medication adherence. A CMA>80% was defined as appropriate medication adherence. Multiple logistic regression analysis was used to identify the factors affecting medication adherence. RESULTS: The average CMA in a total of 85,098 patients was 79.5%. The appropriate adherence (CMA>or=80%) rate was 54.5% and 20.5% of patients had a CMA<50%. Multiple logistic regression analysis revealed that the probability of appropriate adherence decreased with decreasing number of prescription days per visit, increasing number of providers, the patients' residential area moving from urban to rural areas, and when patients have an internal organ disability, auditory impairment, mobility impairment. CONCLUSIONS: The adherence to antihypertensive medication in people with a disability is influenced by various socio-economic, clinical and regional factors. In particular, the disabled who have locomotive and communication disabilities and internal organ impairments have a higher probability of under-adherence to antihypertensive medication adherence in Korea.