Evidence-Based Complementary and Alternative Medicine
Volume 2017 (2017), Article ID 2038095, 31 pages
https://doi.org/10.1155/2017/2038095

Research Article

Use of Western Medicine and Traditional Korean Medicine for Joint Disorders: A Retrospective Comparative Analysis Based on Korean Nationwide Insurance Data

Boyoung Jung,1,2 Sukjin Bae,² and Soyoon Kim3,4

¹Department of Public Health, Graduate School, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
²Research Department, Research Institute of Korean Medicine Policy, 91 Heojun-ro, Gangseo-gu, Seoul 07525, Republic of Korea
³Asian Institute for Bioethics and Health Law (WHO Collaborating Centre for Health Law and Bioethics), Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
⁴Department of International Health, Graduate School of Public Health, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea

Correspondence should be addressed to Boyoung Jung; happiness630@hanmail.net and Soyoon Kim; syoonkim@yuhs.ac

Received 14 August 2017; Accepted 24 October 2017; Published 6 December 2017

Academic Editor: Gihyun Lee

Copyright © 2017 Boyoung Jung et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

This study aimed to compare the usage of Western medicine and traditional Korean medicine for treating joint disorders in Korea. Data of claims from all medical institutions with billing statements filed to HIRA from 2011 to 2014 for the four most frequent joint disorders were used for the analysis. Data from a total of 1,100,018 patients who received medical services from 2011 to 2014 were analyzed. Descriptive statistics are presented as type of care and hospital type. All statistical analyses were performed using IBM SPSS for Windows version 21. Of the 1,100,018 patients with joint disorders, 456,642 (41.5%) were males and 643,376 (58.5%) were females. Per diem costs of hospitalization in Western medicine clinics and traditional Korean medicine clinics were approximately 160,000 KRW and 50,000 KRW, respectively. Among costs associated with Western medicine, physiotherapy cost had the largest proportion (28.78%). Among costs associated with traditional Korean medicine, procedural costs and treatment accounted for more than 70%, followed by doctors’ fees (21.54%). There were distinct differences in patterns of medical care use and cost of joint disorders at the national level in Korea. This study is expected to contribute to management decisions for musculoskeletal disease involving joint disorders.

1. Introduction

Musculoskeletal diseases are one of the leading causes of disability worldwide. It is a major contributor to health burden and health care costs [1]. Korea has a rapidly aging population due to the decrease in birth rate and increase in life expectancy. The percentage of the population aged 65 years or older will increase from 10.3% in 2008 to 15.6% in 2020 and 38.2% in 2050 [2]. Previous studies have reported findings on the prevalence of musculoskeletal disease [3, 4]. As the Korean population continues to age, the economic burden of musculoskeletal disease will continue to increase. The total economic burden of treating musculoskeletal is about 8.1 billion dollars [2]. Musculoskeletal diseases are the most common health problems that require the use of traditional Korean medicine [5], an integral part of prevailing practice and belief systems throughout Korea’s history. Starting from the late 19th century, Western medical practices were introduced by Christian missionaries to Korea. These practices quickly supplanted traditional Korean medicine in institutional health care. After the Korean War, the government revived interest in traditional Korean medicine and established colleges that specialize in that field, in addition to colleges of Western medicine [6]. With this historical background, the Korean medical system is characterized by a dual [7, 8], mutually exclusive medical system consisting of Western medicine and traditional Korean medicine practices [9]. In Korea, primary care physicians work mostly in solo private practices and are reimbursed on a fee-for-service basis. This system enables patients to choose and retain individual physicians regardless of changes in employment status. Therefore, Koreans can use both Western and traditional Korean medicine to treat musculoskeletal disorders. Previous studies have assessed the prevalence and cost of Korean medicine [5, 6, 10–13]. However, most of these studies did not focus on joint disorders [11, 14–16]. Particularly, the statuses of health care utilization associated with joint disorders including the scale of the whole population and health care costs of patients receiving treatment for joint disorders are currently unknown. Therefore, the objective of this study was to analyze claim data submitted to the Korean National Health Insurance (NHI) and assessed by the Health Insurance Review and Assessment Service (HIRA) to compare medical care use between Western medicine and traditional Korean medicine. The results of this study will provide basic information for future management decisions for musculoskeletal diseases especially joint disorders in Korea.

2. Materials and Methods

2.1. Data Source

This study used claims data from the 2011–2014 National Patient Sample (NPS) dataset of HIRA. Datasets generated and/or analyzed for this study period are available from the HIRA-NPS repository [17]. The NPS includes 3% sample data of 2011–2014 national insurance billing data. It can represent the country as a whole (46 million patients). The total number of filed claims and total health expenditure have increased steadily. As of 2011, the total number of filed claims has reached 1.3 billion, with a total health expenditure of ~51.5 trillion KRW. Patients were stratified according to sex and age in 5-year intervals. These HIRA claim data are compiled by health care providers nationwide. They correspond to the number of claims submitted by patients. Claims from patients with the Medicaid program, government expenditures, and veteran patients are also included in these claim data [18]. All data were deidentified to ensure patient confidentiality. The HIRA Research Ethics Committee of South Korea approved the study protocol.

2.2. Study Population

After reviewing frequent diseases each year in traditional Korean medicine as described previously [19], patients with the following four most frequent joint disorders were included in this study: M17 (gonarthrosis [arthrosis of knee]), M75 (shoulder lesions), S63 (dislocation, sprain, and strain of joints and ligaments at wrist and hand level), and S93 (dislocation, sprain, and strain of joints and ligaments at ankle and foot level). Although dorsalgia (M54) was at the top of the list, it was excluded from analysis since there was no change in ranking by year. To observe changes in the ranking of diseases by year, the remaining joints were included in the study. We focused on musculoskeletal disorders and injuries of the extremities. The diagnoses were coded using the 6th revision of the Korean Classification of Diseases (KCD-6) adapted from the International Classification of Diseases, 10th revision. Data from the billing statements for patients with missing cost data and those with zero total cost were excluded. Patient might have visited more than once during the study period (i.e., more than one claim per patient). Therefore, the number of claims in this study was higher than the total number of patients. A total of 7,996,903 claims for 1,100,018 patients with joint diseases with prefix codes of M17, M75, S63, and S93 in primary diagnoses were included for analysis through discussion of a panel of three clinicians (one public health specialist, one Korean medical doctor, and one statistician). A total of 1,100,018 patients were finally included in our analysis (Figure 1).

Figure 1: Flowchart of the study sample.

2.3. Episode Creating Process

Claims data provided by HIRA included raw data of treatment prescriptions for all patients who received medical services over the course of one year after removing personal and corporate information. Because the claims were submitted monthly, charges in the statement reflected up to one month of information. In other words, patients who had been hospitalized for more than one month would have been charged separately for each month. In such cases, errors such as overestimation of the number of inpatients and underestimation of medical expenses might occur when performing statistical analyses. Therefore, episodes, involving collecting and calibrating several claims charged monthly for one consecutive medical practice were used. In this study, separated claim forms of hospitalized patients were bundled into one hospitalization episode. Variables used in the episode creating process included claims identification key, patient identification key, insurance type, main diagnosis code, treatment type, treatment start date, and treatment end date.

2.4. Main Descriptive Variables

The main descriptive variables were frequency and cost of medical care without addressing a specific hypothesis. Frequency included the number of hospitalizations and outpatient visits in Western medicine and traditional Korean medicine clinics, intervention (surgical and nonsurgical), and annual usage. Rehabilitation-related nonsurgical interventions were classified according to National Evidence-based Healthcare Collaborating Agency reports [20].

Cost included average cost per patient and cost per day (per diem) for joint disorders. Medical costs determined to be eligible for reimbursement by HIRA out of treatment costs were indicated in the submitted insurance claim statement. Medical costs, that is, the sum of benefits reimbursed by the insurer (Korean National Health Insurance Service) to the medical care institutions, were classified as INSUP and self-payment costs paid by the beneficiary (patient) as SLF. It was expressed as total treatment cost in Korean Won (1,000,000 KRW). Each patient’s medical costs were calculated as the sum of costs listed on their claims. The average treatment amount was the amount of total medical expenses for one year divided by the number of patients. Per diem was the amount of total medical expenses for one year divided by the number of days of hospitalization or in an outpatient clinic.

The number of reimbursed days included the number of hospitalized days or outpatient visits and in-care drug prescription days. These days were defined based on the number of visits (for outpatient departments) or the length of hospital stay (for inpatient departments) of patients indicated in the submitted insurance claim statement [14]. Days per episode were calculated as total reimbursed days divided by the total number of episodes. Patient and medical institution-related characteristics are defined as follows.

2.5. Patient Characteristics

Patient characteristics included gender, age, medical insurance type, severity of disease, existence of surgery, and type of medicine. The main attending hospital characteristics included hospital type, region, ownership, the number of beds, the number of Western doctors, and the number of traditional medical practitioners. Patient demographic data obtained from the NHI claims database included gender, age, and medical insurance type (NHI, Medicaid, and others) at the date of visit of a health care institution and the most frequently visited ones. Individuals were qualified for Medicaid if they had a household income of less than $600 per month. Medical services for veterans and beneficiaries were free of charge as government expenditure. Severity was measured using the Charlson Comorbidity Index (CCI) [21] defined as the sum of weights related to each condition for which a patient had available claim data. The CCI score was determined based on the presence of specific ICD-10 codes during one year [22]. In this study, CCI at initiation was used as the CCI score of each patient.

2.6. Medical Institution Characteristics

The types of medical practice were divided into three as follows: traditional, Western, and both traditional and Western. Hospital was the main attending medical institution which was visited most frequently by the patient for care. If visit frequency per institution was the same, the main attending hospital was the last health care institution that the patient visited. Medical institutions included Tertiary and General Hospitals, hospitals, long-term care hospitals, Western Clinics, Dental Hospitals and Clinics, Public Health Hospitals (admission facility-equipped health center), Public Health Centers, Local Public Health Clinics, Traditional Hospitals, and Traditional Clinics. Region and ownership were the characteristics of the medical institution that the patient visited.

2.7. Statistical Analysis

Basic characteristics of the study sample are presented as frequencies and percentages. They are presented for each operational definition. Descriptive statistics are presented as type of care and hospital type. All statistical analyses were performed using SPSS version 21 for Windows (IBM Corp., Armonk, NY, USA).

3. Results

The general characteristics of the study population are summarized in Table 1.

Table 1: General characteristics of patients and hospitals.

Category
2011
2012
2013
2014
Total

(%)

(%)

(%)

(%)

(%)

Patient total
268,048
(100)
273,752
(100)
278,170
(100)
280,048
(100)
1,100,018
(100.0)

Gender

    Male
111,101
(41.4)
113,592
(41.5)
115,219
(41.4)
116,730
(41.7)
456,642
(41.5)

    Female
156,947
(58.6)
160,160
(58.5)
162,951
(58.6)
163,318
(58.3)
643,376
(58.5)

Age (yr)

    ≦29
64,226
(24.0)
64,564
(23.6)
63,712
(22.9)
63,696
(22.7)
256,198
(23.3)

    30–39
27,303
(10.2)
27,272
(10.0)
27,047
(9.7)
27,176
(9.7)
108,798
(9.9)

    40–49
42,286
(15.8)
41,452
(15.1)
41,118
(14.8)
40,898
(14.6)
165,754
(15.1)

    50–59
53,565
(20.0)
56,005
(20.5)
58,252
(20.9)
58,201
(20.8)
226,023
(20.5)

    60–69
44,704
(16.7)
46,016
(16.8)
46,949
(16.9)
47,162
(16.8)
184,831
(16.8)

    70–79
35,964
(13.4)
38,443
(14.0)
41,092
(14.8)
42,915
(15.3)
158,414
(14.4)

Medical insurance

    National Health Insurance
255,160
(95.2)
261,381
(95.5)
266,015
(95.6)
268,135
(95.7)
1,050,691
(95.5)

    Medicaid
12,828
(4.8)
12,298
(4.5)
12,069
(4.3)
11,817
(4.2)
49,012
(4.5)

    Others
60
(.0)
73
(.0)
86
(.0)
96
(.0)
315
(.0)

Lesion of

    M17
141,148
(52.6)
143,697
(52.4)
145,346
(52.3)
147,274
(52.6)
577,465
(52.5)

    M75&
16,677
(6.2)
16,401
(6.0)
17,223
(6.2)
16,858
(6.0)
67,159
(6.1)

    S63
46,659
(17.4)
47,900
(17.5)
48,776
(17.6)
49,269
(17.6)
192,604
(17.5)

    S93
63,564
(23.7)
65,754
(24.0)
66,825
(24.0)
66,647
(23.8)
262,790
(23.9)

Severity

    0
157,575
(74.4)
154,798
(74.4)
151,540
(74.3)
115,851
(58.4)
579,764
(70.5)

    1
37,600
(17.7)
37,236
(17.9)
36,331
(17.8)
49,180
(24.8)
160,347
(19.5)

    2
11,630
(5.5)
11,245
(5.4)
11,097
(5.4)
21,684
(10.9)
55,656
(6.8)

    3+
5,041
(2.4)
4,792
(2.3)
4,874
(2.4)
11,556
(5.8)
26,263
(3.2)

Surgery

    No
264,211
(98.6)
269,325
(98.4)
273,412
(98.3)
275,029
(98.2)
1,081,977
(98.4)

    Yes
3,837
(1.4)
4,427
(1.6)
4,758
(1.7)
5,019
(1.8)
18,041
(1.6)

Patient total
268,048
(100.0)
273,752
(100.0)
278,170
(100.0)
280,048
(100.0)
1,100,018
(100.0)

Type of medicine

    Traditional
64,453
(24.1)
63,426
(23.2)
63,234
(22.7)
61,159
(21.8)
252,272
(22.9)

    Both
40,901
(15.3)
40,824
(14.9)
41,482
(14.9)
40,793
(14.6)
164,000
(14.9)

    Western
162,550
(60.7)
169,502
(61.9)
173,454
(62.4)
178,096
(63.6)
683,602
(62.2)

Hospital

    Tertiary and General Hospital
13,100
(4.9)
14,125
(5.2)
14,911
(5.4)
16,109
(5.8)
58,245
(5.3)

    Hospital
25,672
(9.6)
29,657
(10.8)
30,968
(11.1)
32,111
(11.5)
118,408
(10.8)

    Western Clinic
1,912
(.7)
2,138
(.8)
2,268
(.8)
2,320
(.8)
8,638
(.8)

    Long-term care hospital
145,278
(54.2)
146,694
(53.6)
149,037
(53.6)
151,146
(54.0)
592,155
(53.8)

    Traditional Hospital
1,631
(.6)
1,631
(.6)
1,628
(.6)
1,583
(.6)
6,473
(.6)

    Traditional Clinic
80,423
(30.0)
79,507
(29.0)
79,357
(28.5)
76,779
(27.4)
316,066
(28.7)

Region

    Seoul (Urban)
52,548
(19.6)
53,682
(19.6)
54,538
(19.6)
54,907
(19.6)
215,675
(19.6)

    Metropolitan city
68,101
(25.4)
70,626
(25.8)
72,117
(25.9)
72,436
(25.9)
283,280
(25.8)

    Other (Rural)
147,399
(55.0)
149,444
(54.6)
151,515
(54.5)
152,705
(54.5)
601,063
(54.6)

Ownership

    Public
1,894
(.7)
1,916
(.7)
2,018
(.7)
2,120
(.8)
7,948
(.7)

    Corporation
20,395
(7.6)
22,750
(8.3)
23,386
(8.4)
24,272
(8.7)
90,803
(8.3)

    Private
245,726
(91.7)
249,084
(91.0)
252,765
(90.9)
253,654
(90.6)
1,001,229
(91.0)

Number of beds

    ≦5
254,565
(95.0)
261,339
(95.5)
265,257
(95.4)
266,216
(95.1)
1,047,377
(95.2)

    6–12
8,455
(3.2)
7,626
(2.8)
7,959
(2.9)
8,635
(3.1)
32,675
(3.0)

    13–17
2,195
(.8)
2,444
(.9)
2,401
(.9)
2,542
(.9)
9,582
(.9)

    18≦
2,820
(1.1)
2,343
(.9)
2,552
(.9)
2,655
(.9)
10,370
(.9)

Number of Western doctors per 100 beds

    ≦4
172,528
(64.4)
257,710
(94.3)
260,076
(93.7)
260,036
(93.0)
950,350
(86.5)

    5–11
70,428
(26.3)
11,177
(4.1)
12,686
(4.6)
14,624
(5.2)
108,915
(9.9)

    12–19
13,829
(5.2)
2,055
(.8)
1,897
(.7)
2,451
(.9)
20,232
(1.8)

    20≦
11,231
(4.2)
2,469
(.9)
2,976
(1.1)
2,474
(.9)
19,150
(1.7)

Number of traditional doctors per 100 beds

    0
262,580
(98.0)
270,211
(99.3)
274,766
(99.4)
276,741
(99.4)
1,084,298
(99.0)

    1≦
5,436
(2.0)
1,796
(.7)
1,753
(.6)
1,686
(.6)
10,671
(1.0)

edical insurance type divided into National Health Insurance, Medicaid, and others. Others include veterans and beneficiaries who receive care free of charge as a government expenditure. hen one patient had multiple joint diseases, the most frequent disease is indicated. case involving one or more of the other three joint disorders which were included in this study. everity was measured using the Charlson Comorbidity Index (CCI), defined as the sum of weights related to each condition for which a patient submitted claims. ospital type is the type of medical institution most frequently visited.

A total of 1,100,018 patients were included, including 456,642 (41.5%) males and 643,376 (58.5%) females. All four years (from 2011 to 2014) showed higher percentages of females than males. Patients under 29 years of age accounted for the largest proportion (23.3%), followed by patients in their 50s (20.5%) and 60s (16.8%). A total of 1,050,691 (95.5%) patients were enrolled in the NHI scheme while the remaining 49,012 patients (4.5%) were enrolled in Medicaid. Patients with knee arthrodesis accounted for the most (24.2%), followed by those with foot joint disease. More than half (52.5%) of these patients had knee arthropathy. Approximately 70% (70.5%) of patients had mild joint disorder with CCI score of 0. Among the 1,100,018 patients, 18,041 (1.6%) patients underwent surgery while the majority (98.4%) of patients underwent nonsurgical procedures. For body regions where basic physical therapy was performed more than three times, the knee and shoulder regions accounted for more than 25%. For regions that needed surgery, the knees accounted for the most. For regions that underwent acupuncture two times or more, the shoulder, hand, and foot areas accounted for 30% or more (Table 2). Regardless of disease type, only 1.6% of patients underwent surgery, of which knee surgery was the most frequently performed type (43%~44%). The results of nonsurgical intervention distribution are shown in Table 3. The main attending medical institutions included 58,245 (5.3%) Tertiary and General Hospitals, 118,408 (10.8%) hospitals, 8,638 (0.8%) Western Clinics, 592,155 (53.8%) long-term care hospitals, 6,473 (29.6%) Traditional Hospitals, and (28.7%) Traditional Clinics. However, the results were different for hospitalization and outpatient visits (Table 4). Hospitalization was mainly in the order of hospitals > long-term care hospital > Western Clinic. This is mainly due to the characteristics of patients who require surgery. On the other hand, among the same primary clinic institutions, Traditional Clinics showed a higher proportion than Western Clinic for outpatients. The admission rates were 96.90% in Western medicine clinic and 3.10% in traditional Korean medicine clinics. Among all outpatient visits, 67.85% involved orthodox medicine while 32.15% involved traditional Korean medicine. In Western medicine clinics, patients were hospitalized most frequently in hospitals, followed by long-term care hospitals. Hospitalization at hospital level gradually decreased from 37.17% in 2011 to 36.37% in 2014. On the other hand, the percentage of patients who were hospitalized mainly in Traditional Hospitals increased from 2.12% in 2011 to 3.28% in 2014. Outpatient visits accounted for most visits to hospitals (Western medicine: 56.26%; Traditional Korean medicine: 31.69%). While the percentage of outpatients at Western medicine clinics steadily increased from 66.19% in 2011 to 68.93% by 2014, the percentage of outpatients at traditional Korean medicine clinics steadily decreased from 33.81% in 2011 to 31.07% in 2014. Most (91.0%) institutions were privately owned, and most (80.4%) of them were located outside Seoul. The majority (95.2%) of institutions had fewer than 5 beds. There was no significant difference among the four groups according to year. The total average treatment cost (RPE) is the sum of INSUP and SLF paid to medical care institution. RPE per patient was 185,933 KRW in 2011, 192,290 KRW in 2012, 202,967 KRW in 2013, and 208,739 KRW in 2014. Women incurred more medical expenses in 2011 to 2014 compared to men. Expenditure was increased with age. It peaked in patients in their 70s with a minimum of 377,448 KRW to a maximum of 388,445 KRW. In terms of expense by the type of joint lesion, knee lesions (M17) had the highest expense among the four types of joint disorders, followed by shoulder lesions (M75). As the severity of lesion was increased, the expense was also increased. However, the difference in expense was not statistically insignificant. Patients who were hospitalized spent 20 times more than those who were not hospitalized. The average treatment costs per patient in inpatient care and outpatient care were 192,414 and 65,319 KRW, respectively. Patients who used only traditional Korean medicine spent twice less than those who only used Western medicine. The range of RPE for Western medicine was from 181,225 KRW to 198,661 KRW. The range of RPE for traditional Korean medicine was from 82,019 KRW to 96,325 KRW. There were no differences in costs over 400,000 KRW among hospitals that practiced Western medicine (Tertiary and General Hospital, hospital, and Western Clinic). Costs for Western medicine hospitals were the highest, followed by that for Traditional Hospitals and long-term care hospitals (Table 5).

Table 2: Distribution of nonsurgical intervention in both WM and traditional medicine according to the corporal name.

Nonsurgical intervention

2011
2012

Total
M17
M75
S63
S93
Total
M17
M75
S63
S93

Total
()
1,481,969
648,757
447,224
136,972
249,016
1,560,032
683,247
471,040
144,044
261,701

WM
Basic physical
0

947,982
377,024
293,443
101,240
176,275
1,000,863
410,595
298,619
106,230
185,419

    %
(63.97)
(58.11)
(65.61)
(73.91)
(70.79)
(64.16)
(60.09)
(63.40)
(73.75)
(70.85)

1

32,582
13,360
6,568
6,504
6,150
38,311
14,819
9,081
7,424
6,987

    %
(2.20)
(2.06)
(1.47)
(4.75)
(2.47)
(2.46)
(2.17)
(1.93)
(5.15)
(2.67)

2

136,773
77,169
33,618
7,892
18,094
137,871
72,622
38,010
8,468
18,771

    %
(9.23)
(11.89)
(7.52)
(5.76)
(7.27)
(8.84)
(10.63)
(8.07)
(5.88)
(7.17)

3≦

364,632
181,204
113,595
21,336
48,497
382,987
185,211
125,330
21,922
50,524

    %
(24.60)
(27.93)
(25.40)
(15.58)
(19.48)
(24.55)
(27.11)
(26.61)
(15.22)
(19.31)

WM
Simple
0

1,475,271
647,748
446,473
132,184
248,866
1,551,724
681,736
469,564
139,023
261,401

    %
(99.55)
(99.84)
(99.83)
(96.50)
(99.94)
(99.47)
(99.78)
(99.69)
(96.51)
(99.89)

1≦

6,698
1,009
751
4,788
150
8,308
1,511
1,476
5,021
300

(.45)
(.16)
(.17)
(3.50)
(.06)
(.53)
(.22)
(.31)
(3.49)
(.11)

WM
Professional
0

1,481,873
648,725
447,185
136,949
249,014
1,560,008
683,235
471,031
144,041
261,701

    %
(99.99)
(100)
(99.99)
(99.98)
(100)
(100)
(100)
(100)
(100)
(100)

1≦

96
32
39
23
2
24
12
9
3
—

    %
(.01)
(.00)
(.01)
(.02)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)

WM
Rehabilitation of CNS
0

1,481,962
648,751
447,223
136,972
249,016
1,560,029
683,244
471,040
144,044
261,701

    %
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)

1≦

7
6
1
—
—
3
3
—
—
—

    %
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)

TM
Acupuncture
0

982,471
512,929
261,161
84,032
124,349
1,062,109
540,051
299,859
88,627
133,572

    %
(66.29)
(79.06)
(58.40)
(61.35)
(49.94)
(68.08)
(79.04)
(63.66)
(61.53)
(51.04)

1

40,678
12,784
14,083
4,402
9,409
44,984
15,421
14,765
4,728
10,070

    %
(2.74)
(1.97)
(3.15)
(3.21)
(3.78)
(2.88)
(2.26)
(3.13)
(3.28)
(3.85)

2≦

458,820
123,044
171,980
48,538
115,258
452,939
127,775
156,416
50,689
118,059

(30.96)
(18.97)
(38.46)
(35.44)
(46.29)
(29.03)
(18.70)
(33.21)
(35.19)
(45.11)

TM
Moxibustion
0

1,481,922
648,728
447,214
136,969
249,011
1,559,985
683,210
471,032
144,043
261,700

    %
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)

1≦

47
29
10
3
5
47
37
8
1
1

    %
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.01)
(.00)
(.00)
(.00)

TM
Cupping
0

1,481,712
648,669
447,115
136,964
248,964
1,559,844
683,132
470,982
144,040
261,690

    %
(99.98)
(99.99)
(99.98)
(99.99)
(99.98)
(99.99)
(99.98)
(99.99)
(100)
(100)

1≦

257
88
109
8
52
188
115
58
4
11

    %
(.02)
(.01)
(.02)
(.01)
(.02)
(.01)
(.02)
(.01)
(.00)
(.00)

TM
Heat & cold therapy
0

1,481,856
648,712
447,194
136,964
248,986
1,559,985
683,225
471,027
144,042
261,691

    %
(99.99)
(99.99)
(99.99)
(99.99)
(99.99)
(100)
(100)
(100)
(100)
(100)

1≦

113
45
30
8
30
47
22
13
2
10

    %
(.01)
(.01)
(.01)
(.01)
(.01)
(.00)
(.00)
(.00)
(.00)
(.00)

Nonsurgical intervention

2013
2014

Total
M17
M75
S63
S93
Total
M17
M75
S63
S93

Total
()
1,594,949
698,540
475,765
150,621
270,023
1,600,774
706,617
468,443
152,359
273,355

WM
Basic physical
0

1,034,024
428,800
302,461
112,026
190,737
1,033,566
432,591
295,844
112,726
192,405

    %
(64.83)
(61.39)
(63.57)
(74.38)
(70.64)
(64.57)
(61.22)
(63.15)
(73.99)
(70.39)

1

46,856
21,507
10,255
7,147
7,947
45,063
18,589
10,106
7,624
8,744

    %
(2.94)
(3.08)
(2.16)
(4.75)
(2.94)
(2.82)
(2.63)
(2.16)
(5.00)
(3.20)

2

126,126
62,627
34,839
9,016
19,644
122,500
59,726
33,139
9,146
20,489

    %
(7.91)
(8.97)
(7.32)
(5.99)
(7.27)
(7.65)
(8.45)
(7.07)
(6.00)
(7.50)

3≦

387,943
185,606
128,210
22,432
51,695
399,645
195,711
129,354
22,863
51,717

    %
(24.32)
(26.57)
(26.95)
(14.89)
(19.14)
(24.97)
(27.70)
(27.61)
(15.01)
(18.92)

WM
Simple
0

1,585,834
696,682
474,267
145,176
269,709
1,590,708
704,479
466,442
146,791
272,996

    %
(99.43)
(99.73)
(99.69)
(96.38)
(99.88)
(99.37)
(99.70)
(99.57)
(96.35)
(99.87)

1≦

9,115
1,858
1,498
5,445
314
10,066
2,138
2,001
5,568
359

(.57)
(.27)
(.31)
(3.62)
(.12)
(.63)
(.30)
(.43)
(3.65)
(.13)

WM
Professional
0

1,594,914
698,521
475,749
150,621
270,023
1,600,736
706,585
468,439
152,358
273,354

    %
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)

1≦

35
19
16
—
—
38
32
4
1
1

    %
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)

WM
Rehabilitation of CNS
0

1,594,942
698,538
475,760
150,621
270,023
1,600,773
706,616
468,443
152,359
273,355

    %
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)

1≦

7
2
5
—
—
1
1
—
—
—

    %
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)

TM
Acupuncture
0

1,085,224
549,587
307,484
89,800
138,353
1,102,972
559,982
309,311
92,009
141,670

    %
(68.04)
(78.68)
(64.63)
(59.62)
(51.24)
(68.90)
(79.25)
(66.03)
(60.39)
(51.83)

1

55,124
23,007
16,632
5,186
10,299
50,447
20,075
15,875
4,656
9,841

    %
(3.46)
(3.29)
(3.50)
(3.44)
(3.81)
(3.15)
(2.84)
(3.39)
(3.06)
(3.60)

2≦

454,601
125,946
151,649
55,635
121,371
447,355
126,560
143,257
55,694
121,844

(28.50)
(18.03)
(31.87)
(36.94)
(44.95)
(27.95)
(17.91)
(30.58)
(36.55)
(44.57)

TM
Moxibustion
0

1,594,876
698,484
475,756
150,619
270,017
1,600,667
706,522
468,436
152,359
273,350

    %
(100.00)
(99.99)
(100)
(100)
(100)
(99.99)
(99.99)
(100)
(100)
(100)

1≦

73
56
9
2
6
107
95
7
—
5

    %
(.00)
(.01)
(.00)
(.00)
(.00)
(.01)
(.01)
(.00)
(.00)
(.00)

TM
Cupping
0

1,594,897
698,507
475,754
150,621
270,015
1,600,518
706,427
468,397
152,357
273,337

    %
(100)
(100)
(100)
(100)
(100)
(99.98)
(99.97)
(99.99)
(100)
(100)

1≦

52
33
11
—
8
256
190
46
2
18

    %
(.00)
(.00)
(.00)
(.00)
(.00)
(.02)
(.03)
(.01)
(.00)
(.01)

TM
Heat & cold therapy
0

1,594,897
698,507
475,754
150,621
270,015
1,600,734
706,584
468,439
152,358
273,353

    %
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)
(100)

1≦

52
33
11
—
8
40
33
4
1
2

    %
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)
(.00)

patient could be hospitalized more than once during the study period, which resulted in more than one claim per patient. Thus, the number of claims in the study was higher than the number of patients. physical therapy included superficial heat therapy, cold therapy, deep heat therapy, UV irradiation, transcutaneous electrical nerve stimulation, massage therapy, and simple therapeutic exercise. rehabilitation included paraffin bath, hydrotherapy, intermittent traction therapy, electrical stimulation therapy, laser therapy, therapeutic exercise, motor point block, pneumatic compression, complex decongestive physical therapy, and iontophoresis. rehabilitation included pool therapy, occupational therapy, activities of daily living training, neurogenic bladder training, functional electrical stimulation therapy, myofascial trigger point injection, rehabilitative social work, rehabilitative breathing therapy, rehabilitative functional training, and rehabilitative dysphagia therapy. M17, knee lesions; M75, shoulder lesions; S63, wrist and hand level lesions; S93, ankle and foot level lesions; WM, Western medicine; TM, Korean traditional medicine.

Table 3: Comparison of rate of surgery by diagnostic code.

Year

Total
Knee lesions [M17]
Shoulder lesions [M75]
Wrist and hand level [S63]
Ankle and foot level [S93]

%

%

%

Total
Unit
1,481,969
100.00
648,757
43.78
447,224
30.18
136,972
9.24
249,016
16.80

2011
No

1,477,896

646,826

445,926

136,436

248,708

%
(99.73)

(99.70)

(99.71)

(99.61)

(99.88)

Yes

4,073

1,931

1,298

536

308

%
(.27)

(.30)

(.29)

(.39)

(.12)

Total
Unit
1,560,032
100.00
683,247
43.80
471,040
30.19
144,044
9.23
261,701
16.78

2012
No

1,555,319

681,193

469,334

143,450

261,342

%
(99.70)

(99.70)

(99.64)

(99.59)

(99.86)

Yes

4,713

2,054

1,706

594

359

%
(.30)

(.30)

(.36)

(.41)

(.14)

Total
Unit
1,594,949
100.00
698,540
43.80
475,765
29.83
150,621
9.44
270,023
16.93

2013
No

1,589,924

696,372

473,895

150,072

269,585

%
(99.68)

(99.69)

(99.61)

(99.64)

(99.84)

Yes

5,025

2,168

1,870

549

438

%
(.32)

(.31)

(.39)

(.36)

(.16)

Total
Unit
1,600,774
100.00
706,617
44.14
468,443
29.26
152,359
9.52
273,355
17.08

2014
No

1,595,458

704,410

466,431

151,772

272,845

%
(99.67)

(99.69)

(99.57)

(99.61)

(99.81)

Yes

5,316

2,207

2,012

587

510

%
(.33)

(.31)

(.43)

(.39)

(.19)

patient could be hospitalized more than once during the study period, which resulted in more than one claim per patient. Thus, the number of claims in the study was higher than the number of patients.

Table 4: Number of hospitalizations and outpatient visits by type of medicine in 2011–2014.

Type of medicine
Hospital type

2011
2012
2013
2014
2011–2014

H
O
H
O
H
O
H
O
H
O

WM
Tertiary Hospital

355
7,860
348
10,697
383
11,051
455
10,817
1,541
40,425

%
4.08
0.53
3.20
0.69
3.05
0.70
3.19
0.68
3.32
0.65

General Hospital

1,123
29,569
1,263
46,307
1,543
47,052
1,677
52,028
5,606
174,956

%
12.92
2.01
11.61
2.99
12.29
2.97
11.74
3.28
12.08
2.83

Hospital

3,232
62,241
4,061
127,047
4,493
131,644
5,193
136,668
16,979
457,600

%
37.17
4.23
37.32
8.20
35.79
8.32
36.37
8.62
36.58
7.39

Long-term care hospital

2,491
3,778
3,504
8,461
4,237
8,142
4,925
8,247
15,157
28,628

%
28.65
0.26
32.20
0.55
33.75
0.51
34.49
0.52
32.66
0.46

Western Clinic

1,296
867,535
1,383
858,553
1,493
874,403
1,508
881,056
5,680
3,481,547

%
14.91
58.92
12.71
55.45
11.89
55.29
10.56
55.56
12.24
56.26

Dental Hospital

0
14
0
38
0
11
0
18
0
81

%
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Public Health Center

0
1,845
0
2,159
0
2,441
0
2,865
0
9,310

%
0.00
0.13
0.00
0.14
0.00
0.15
0.00
0.18
0.00
0.15

Local Public Health Clinic

0
442
0
487
0
245
0
236
0
1,410

%
0.00
0.03
0.00
0.03
0.00
0.02
0.00
0.01
0.00
0.02

Public Health Hospital

2
1,253
1
1,151
3
946
1
1,060
7
4,410

%
0.02
0.09
0.01
0.07
0.02
0.06
0.01
0.07
0.02
0.07

Total

8,499
974,537
10,560
1,054,900
12,152
1,075,935
13,759
1,092,995
44,970
4,198,367

97.75
66.19
97.05
68.13
96.79
68.03
96.35
68.93
96.90
67.85

TM
Traditional Hospital

184
4,035
286
7,932
366
7,680
469
8,818
1,305
28,465

%
2.12
0.27
2.63
0.51
2.92
0.49
3.28
0.56
2.81
0.46

Traditional Clinic

12
493,842
35
485,603
37
497,972
52
483,833
136
1,961,250

%
0.14
33.54
0.32
31.36
0.29
31.49
0.36
30.51
0.29
31.69

Total

196
497,877
321
493,535
403
505,652
521
492,651
1,441
1,989,715

2.25
33.81
2.95
31.87
3.21
31.97
3.65
31.07
3.10
32.15

Total

8,695
1,472,414
10,881
1,548,435
12,555
1,581,587
14,280
1,585,646
46,411
6,188,082

%
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00

with overlapping records were tallied as one patient (overlap was not allowed). H, hospitalization; O, outpatient; WM, Western medicine; TM, Korean traditional medicine.

Table 5: Average treatment amount and benefit per patient by year.

Category
2011
2012
2013
2014

Total
185,933
140,190
45,052
192,290
144,552
47,009
202,967
152,456
49,617
208,739
156,519
51,398

Gender

    Male
130,549
95,580
33,405
135,980
99,443
34,934
145,561
106,375
37,180
153,724
112,670
39,211

    Female
225,139
171,769
53,297
232,227
176,546
55,573
243,557
185,039
58,411
248,061
187,859
60,108

Age (yr)

    ≦29
72,576
50,798
21,766
75,827
53,013
22,798
80,484
56,216
24,252
86,426
60,587
25,825

    30–39
84,267
58,835
25,372
89,666
62,667
26,939
92,840
64,659
27,997
98,049
68,492
29,482

    40–49
121,156
86,493
34,503
127,488
91,277
36,107
134,378
96,345
37,875
141,772
101,542
40,027

    50–59
193,314
139,945
52,833
196,220
141,450
54,582
207,876
150,072
57,232
216,450
157,025
59,170

    60–69
309,243
236,773
70,029
311,086
237,807
70,698
321,981
245,078
73,736
322,749
244,490
75,304

    70–79
377,448
305,038
71,346
382,637
306,720
74,275
391,056
313,167
76,574
388,445
309,676
77,258

Medical insurance type

    NHI
180,246
132,778
46,862
187,175
137,685
48,839
198,249
146,009
51,511
204,759
150,730
53,296

    Medicaid
298,500
288,278
9,262
300,467
291,371
8,384
307,033
295,660
8,220
298,439
289,135
8,745

    Others
302,890
0
0
281,712
720
0
193,558
0
0
285,501
0
0

Lesion of joint

    M17
318,775
247,050
70,286
321,522
247,790
72,013
334,876
258,239
74,930
335,457
257,336
76,387

    M17&
214,173
161,693
51,469
228,679
172,504
55,286
246,375
185,404
59,464
250,494
188,780
60,578

    M75
273,798
204,867
68,361
287,629
215,195
71,603
299,415
223,468
75,254
322,791
240,597
81,185

    S63
59,589
41,837
17,681
60,432
42,435
17,970
62,989
44,297
18,650
67,402
47,452
19,899

    S63&
145,409
103,545
41,771
154,690
110,097
44,542
162,736
116,024
46,700
173,306
123,653
49,639

    S93
80,779
56,892
23,850
83,765
58,891
24,844
88,453
62,166
26,253
94,310
66,510
27,765

Severity (CCI)

    0
203,081
153,881
48,398
209,020
157,743
50,440
221,676
167,186
53,420
157,944
115,659
42,148

    1
199,087
150,625
47,563
211,708
159,868
50,817
223,060
168,461
53,604
273,424
207,024
65,595

    2
212,462
161,156
50,725
204,987
155,273
49,011
230,624
174,488
55,662
371,890
287,348
82,390

    3+
204,016
154,551
48,973
247,400
188,624
57,910
244,925
186,833
57,180
470,263
368,719
93,844

Hospital admission

    No
120,367
88,290
31,661
121,813
89,057
32,334
126,287
92,267
33,586
131,932
96,429
35,035

    Yes
3,192,333
2,519,960
659,078
2,972,861
2,334,061
625,995
2,932,509
2,294,974
620,271
2,689,568
2,097,376
579,924

Inpatient visit

    1≦
172,322
129,370
42,262
178,367
133,526
44,130
187,228
140,111
46,235
192,414
143,780
47,833

Outpatient visit

    1
61,372
44,201
16,944
58,572
42,469
15,878
61,113
44,077
16,623
65,319
47,296
17,866

    2-3
167,073
123,186
43,449
156,721
114,800
41,323
165,529
121,119
43,911
172,643
125,955
46,092

    4≦
511,061
393,692
115,248
536,884
410,668
124,195
562,200
430,102
129,674
572,730
437,335
132,812

Type of medicine

    Traditional
82,019
61,845
20,154
86,266
65,161
21,076
90,827
68,827
21,979
96,325
73,323
22,966

    Both
368,924
280,760
87,644
382,499
290,307
91,415
410,128
310,688
97,825
421,279
318,877
101,784

    Western
181,225
135,985
44,240
186,151
139,155
46,017
194,305
145,102
48,164
198,661
147,900
49,621

Hospital type

    Tertiary and General Hospital
489,902
358,403
120,547
499,923
365,372
124,248
521,851
379,551
129,039
513,518
373,917
129,108

    Hospital
400,853
302,498
97,522
400,137
301,007
97,878
403,412
303,041
99,363
401,838
299,704
101,105

    Western Clinic
439,283
346,145
92,816
490,846
388,042
102,269
549,396
431,928
117,009
601,268
473,599
125,127

    Long-term care hospital
151,730
115,386
36,252
152,247
115,222
36,955
161,165
121,970
39,115
164,468
124,275
40,104

    Traditional Hospital
170,319
116,816
53,366
190,266
132,261
57,678
206,204
143,719
62,073
254,941
178,466
76,299

    Traditional Clinic
123,954
93,265
30,612
126,000
94,782
31,157
133,370
100,470
32,823
138,372
104,463
33,798

Region

    Seoul (Urban)
193,889
144,031
48,933
204,091
151,668
51,127
207,939
153,673
52,466
217,649
161,097
55,268

    Metropolitan city
206,956
156,123
49,511
205,397
154,325
49,914
222,903
167,268
54,395
224,130
168,026
54,704

    Other (Rural)
173,384
131,459
41,609
181,856
137,378
44,157
191,688
144,969
46,317
198,235
149,414
48,438

Ownership

    Private
356,865
272,144
78,988
502,172
389,016
108,319
458,967
355,555
96,233
446,919
343,020
100,664

    Corporation
399,808
296,961
96,104
395,387
293,375
95,243
414,433
306,100
100,105
428,235
315,244
105,371

    Public
166,882
126,175
40,558
171,357
129,080
42,132
181,359
136,620
44,574
185,744
139,770
45,822

sum of INSUP and SLF paid to the medical care institution. The total costs of items determined to be eligible for reimbursement by the HIRA (Health Insurance Review and Assessment Service) out of the total treatment amount were indicated in the submitted insurance claim statement. : the cost reimbursed by the Korean National Health Insurance Service as the insurer. : the self-payment amount paid by the beneficiary. case involving one or more of the other three joint disorders which were included in this study.

The frequency and total medical expenditures for Western medicine and traditional Korean medicine are shown in Table 6. There were 21,894,252 claims with a cost of 168,024,474 (1000 KRW) for Western medicine. However, there were only 9,628,946 claims with a cost of 38,602,696 (1000 KRW) for traditional Korean medicine. The medical expense per visit in an outpatient clinic was 22,000 KRW for Western medicine and about 18,000 KRW for traditional Korean medicine. The day per episode of traditional Korean medicine was longer than that of Western medicine. After analyzing the medical cost of claims for Western medicine and traditional Korean medicine, the proportion of each item was different. For Western medicine, the proportion of psychiatric costs was the highest (28.78%), followed by doctors’ fees (27.7%), injections (16.59%), radiotherapy costs (8.74%), and laboratory costs (7.09%). For traditional Korean medicine, the proportion of doctors’ fees was the highest (26.48%), followed by procedural costs (25.16%), injections (13.52%), admission costs (9.23%), and psychiatric costs (7.26%). Regarding traditional Korean medicine, most (70%) medical treatment costs were procedural costs and treatment costs. Doctors’ fees accounted for only 21.54% of the total cost, similar to doctors’ fees for Western medicine. Procedural costs accounted for the most (56.45%) among total cost for Western medicine. The second largest proportion was doctors’ fees (40.49%). Admission costs, medication costs, and laboratory costs comprised less than 1% (Table 7).

Table 6: Comparison of medical costs by type of medicine in 2011–2014.

Unit
Year
Type of medicine
Frequency
Insurance charge
LOS

%

%
Per
Days per

H
2011
WM
8,499
97.75
16,542
99.37
162,276
10.98

TM
196
2.25
105
0.63
53,097
12.23

Total
8,695
100
16,647
100
159,815
11.01

2012
WM
10,560
97.05
18,063
99.03
157,605
9.67

TM
321
2.95
178
0.97
57,256
12.18

Total
10,881
100
18,240
100
154,644
9.75

2013
WM
12,152
96.79
19,969
98.65
155,222
9.31

TM
403
3.21
216
1.35
62,217
10.78

Total
12,555
100
20,185
100
152,237
9.35

2014
WM
13,759
96.35
20,077
98.65
154,829
8.51

TM
521
3.65
276
1.35
60,435
10.72

Total
14,280
100
20,353
100
151,385
8.59

O
2011
WM
974,537
66.19
23,827
71.81
22,030
1.2

TM
497,877
33.81
9,354
28.19
18,573
1.04

Total
1,472,414
100
33,181
100
20,861
1.15

2012
WM
1,054,900
68.13
24,848
72.24
23,555
1.12

TM
493,535
31.87
9,551
27.76
19,352
1.03

Total
1,548,435
100
34,399
100
22,215
1.09

2013
WM
1,075,935
68.03
26,203
72.24
24,354
1.11

TM
505,652
31.97
10,071
27.76
19,917
1.03

Total
1,581,587
100
36,274
100
22,935
1.08

2014
WM
1,092,995
68.93
27,887
73.19
25,514
1.1

TM
492,651
31.07
10,218
26.81
20,740
1.03

Total
1,585,646
100
38,104
100
24,031
1.08

patient could be hospitalized more than once during the study period, which resulted in more than one claim per patient. Thus, the number of claims in the study was higher than the number of patients. determined to be eligible for reimbursement by the HIRA (Health Insurance Review and Assessment Service) out of the total treatment amount were indicated in the submitted insurance claim statement. Costs are expressed in Korean Won (1,000,000 KRW). diem is the average daily cost of services covered by National Health Insurance. It is expressed in Korean Won. per episode are the total number of reimbursed days divided by the total number of episodes. The number of reimbursed days includes the number of hospitalized days or outpatient visits and in-care drug prescription days. H, hospitalization; O, outpatient; WM, Western medicine; TM, Korean traditional medicine.

Table 7: Comparison of subgroup costs by type of medicine (2011–2014).

Type
Unit
Doctors’ fees
Admission costs
Medication costs
Injection costs
Anesthesia costs
Physiotherapy costs
Psychotherapy costs
Procedural costs
Laboratory costs
Radiotherapy costs
None

WM

6,064,234
178,833
614,097
3,632,780
697,677
6,300,815
194
791,129
1,551,682
1,914,274
148,537
21,894,252

%
27.7
0.82
2.8
16.59
3.19
28.78
0
3.61
7.09
8.74
0.68
100

KRW
44,499,914
15,515,383
2,477,317
22,718,121
9,271,746
12,202,897
3,897
42,278,059
5,393,884
10,074,191
3,589,065
168,024,474

%
26.48
9.23
1.47
13.52
5.52
7.26
0
25.16
3.21
6
2.14
100

TM

2,074,061
6,648
332,810
0
0
0
3
6,932,215
8,192
0
275,017
9,628,946

%
21.54
0.07
3.46
0
0
0
0
71.99
0.09
0
2.86
100

KRW
15,631,220
592,114
208,776
0
0
0
31
21,791,571
31,038
0
347,946
38,602,696

%
40.49
1.53
0.54
0
0
0
0
56.45
0.08
0
0.9
100

Total

8,138,295
185,481
946,907
3,632,780
697,677
6,300,815
197
7,723,344
1,559,874
1,914,274
423,554
31,523,198

%
25.82
0.59
3
11.52
2.21
19.99
0
24.5
4.95
6.07
1.34
100

KRW
60,131,134
16,107,497
2,686,093
22,718,121
9,271,746
12,202,897
3,929
64,069,631
5,424,922
10,074,191
3,937,011
206,627,170

%
29.1
7.8
1.3
10.99
4.49
5.91
0
31.01
2.63
4.88
1.91
100

determined to be eligible for reimbursement by the HIRA (Health Insurance Review and Assessment Service) out of the total treatment amount were indicated in the submitted insurance claim statement. They are expressed as Korean Won (1,000 KRW).

In Table 8, it was not possible to use the inspection and image capturing system of 0 only in the Traditional Clinic because of legal restrictions. According to the region of disease, the knee accounted for the most, followed by the shoulder, foot, and hand in terms of hospitalization and outpatient visits. As the years progressed, the number of inpatient and outpatient visits was also increased for all body regions. Among the hospitalized patients, the number of claims for all years after 2011 increased the most for shoulder joints (78.43%) compared to 2011, followed by knees (61.93%), foot (50.72%), and hands (16.29%). On the other hand, outpatient cases occurred in the following order based on the location of the disease: hand (11.24%) > knee (8.49%) > ankle (9.63%) > shoulder (4.35%). According to time (year), difference in current usage patterns was especially different between Western medicine and traditional Korean medicine. Particularly, hospitalization increases for the knee and shoulder areas (shoulder: 105.00%, knee: 250.00%) in traditional Korean medicine were higher than those in Western medicine (shoulder: 77.99%, knee: 58.04%). The proportion of outpatient visits for the hand region in traditional Korean medicine increased steadily (2012: 4.31%, 2013: 14.49%, 2014: 13.46%). However, the shoulder area showed steady decrease (2011: −8.31%, 2012: −9.73%, 2014: −16.45%) (Table 9).

Table 8: Comparison of subgroup related to type of medicine.

Type
Hospital type
Doctors’ fees
Admission costs
Medication costs
Procedural costs
Anesthesia costs
Psychotherapy costs
Psychiatric costs
Injection costs/procedural costs
Laboratory costs
Radiotherapy costs
Total

TM
Tertiary Hospital
(11.96)
(2.36)
(6.43)
(7.60)
(2.34)
(3.56)
(.01)
(15.63)
(30.35)
(19.76)
(100)

General Hospital
(17.14)
(2.52)
(9.43)
(6.95)
(1.87)
(8.68)
(.01)
(15.35)
(21.44)
(16.61)
(100)

Hospital
(17.52)
(2.44)
(5.93)
(6.24)
(2.56)
(14.34)
(.00)
(17.23)
(19.82)
(13.94)
(100)

Long-term care hospital
(23.67)
(3.96)
(3.39)
(.76)
(.87)
(17.46)
(.00)
(44.73)
(1.85)
(3.31)
(100)

Western Clinic
(31.99)
(.18)
(1.29)
(2.58)
(3.54)
(35.12)
(.00)
(16.82)
(1.98)
(6.50)
(100)

Dental Hospital
(17.57)
(.00)
(.42)
(.00)
(.00)
(.00)
(.00)
(82.01)
(.00)
(.00)
(100)

Public Health Center
(.00)
(.00)
(.08)
(1.48)
(.00)
(96.83)
(.00)
(.35)
(1.21)
(.03)
(100)

Local Public Health Clinic
(.00)
(.00)
(49.13)
(.34)
(.00)
(47.29)
(.00)
(2.68)
(.55)
(.00)
(100)

Public Health Hospital
(35.19)
(.20)
(4.47)
(2.06)
(.16)
(18.89)
(.00)
(29.61)
(2.62)
(6.79)
(100)

WM
Traditional Hospital
(17.99)
(3.57)
(2.61)
(.08)
(.46)
(1.44)
(.00)
(68.04)
(4.17)
(1.64)
(100)

Traditional Clinic
(21.61)
(.01)
(6.44)
(.00)
(.09)
(.00)
(.00)
(71.86)
(.00)
(.00)
(100)

Total
(25.94)
(.59)
(3.89)
(2.52)
(2.25)
(20.08)
(.00)
(33.67)
(4.95)
(6.10)
(100)

WM, Western medicine; TM, Korean traditional medicine.

Table 9: Comparison of lesion frequency by type of medical practice in 2011–2014.

Class
Year
Type
Knee lesions [M17]
Shoulder lesions [M75]
Wrist and hand level [S63]
Ankle and foot level [S93]

%

%

%

%

H
2011
WM

5,024
97.97

2,399
98.36

216
97.74

860
94.82

TM

104
2.03

40
1.64

5
2.26

47
5.18

Total

5,128
100.00

2,439
100.00

221
100.00

907
100.00

2012
WM
25.72
6,316
96.74
27.97
3,070
97.90
−5.56
204
97.61
12.79
970
96.33

TM
104.81
213
3.26
65.00
66
2.10
0.00
5
2.39
−21.28
37
3.67

Total
27.32
6,529
100.00
28.58
3,136
100.00
−5.43
209
100.00
11.03
1,007
100.00

2013
WM
41.04
7,086
96.45
53.61
3,685
98.03
21.76
263
98.50
30.00
1,118
94.59

TM
150.96
261
3.55
85.00
74
1.97
−20.00
4
1.50
36.17
64
5.41

Total
43.27
7,347
100.00
54.12
3,759
100.00
20.81
267
100.00
30.32
1,182
100.00

2014
WM
58.04
7,940
95.62
77.99
4,270
98.12
17.13
253
98.44
50.70
1,296
94.81

TM
250.00
364
4.38
105.00
82
1.88
−20.00
4
1.56
51.06
71
5.19

Total
61.93
8,304
100.00
78.43
4,352
100.00
16.29
257
100.00
50.72
1,367
100.00

O
2011
WM

508,830
79.13

258,936
58.24

83,624
61.16

123,147
49.65

TM

134,181
20.87

185,699
41.76

53,106
38.84

124,891
50.35

Total

643,011
100.00

444,635
100.00

136,730
100.00

248,038
100.00

2012
WM
5.41
536,381
79.33
14.91
297,536
63.60
5.76
88,439
61.49
7.63
132,544
50.85

TM
4.18
139,790
20.67
−8.31
170,259
36.40
4.31
55,394
38.51
2.56
128,092
49.15

Total
5.16
676,171
100.00
5.21
467,795
100.00
5.19
143,833
100.00
5.08
260,636
100.00

2013
WM
7.14
545,161
78.94
17.50
304,245
64.47
7.08
89,546
59.56
11.24
136,983
50.96

TM
8.37
145,411
21.06
−9.73
167,639
35.53
14.49
60,801
40.44
5.53
131,801
49.04

Total
7.40
690,572
100.00
6.13
471,884
100.00
9.96
150,347
100.00
8.36
268,784
100.00

2014
WM
9.18
555,535
79.63
17.99
305,510
65.84
9.83
91,843
60.39
13.77
140,107
51.52

TM
5.90
142,092
20.37
−16.45
155,153
0.72
13.46
60,252
39.61
5.55
131,824
48.48

Total
8.49
697,627
100.00
4.35
463,993
100.00
11.24
152,095
100.00
9.63
271,931
100.00

with overlapping records were tallied as one patient (overlap was not allowed). rate compared to 2011. H, hospitalization; O, outpatient; WM, Western medicine; TM, traditional Korean medicine.

The costs and length of hospitalization by year are shown in Tables 10–17. Basic physical therapy was the most common nonsurgical intervention in Western medicine while acupuncture was the most common nonsurgical intervention in traditional Korean medicine. Both procedures are steady treatments that require two or more treatments. The proportions of acupuncture and basic physical therapy are almost equal (Table 18).

Table 10: Numbers of hospitalizations for gonarthrosis [M17] patients by hospital type.

Year
Type of medicine
Hospital type
Frequency
Hospitalization costs
LOS

%

%
Per
Days per

2011
Western
Tertiary Hospital
204
3.98
1,225
9.50
460,420
14.20

General Hospital
589
11.49
3,215
24.93
254,225
22.53

Hospital
1,689
32.94
7,044
54.62
225,222
17.68

Long-term care hospital
1,857
36.21
553
4.29
94,819
4.42

Western Clinic
683
13.32
794
6.16
81,749
13.64

Public Health Hospital
2
0.04
1
0.01
39,420
11.00

Total
5,024
97.97
12,832
99.50
170,393
12.66

Traditional
Traditional Hospital
99
1.93
62
0.48
57,349
13.10

Traditional Clinic
5
0.10
2
0.02
33,235
13.80

Total
104
2.03
64
0.50
56,190
13.13

Total

5,128
100.00
12,896
100.00
168,077
12.67

2012
Western
Tertiary Hospital
187
2.86
1,190
8.81
490,276
14.06

General Hospital
615
9.42
3,188
23.60
236,169
22.07

Hospital
2,011
30.80
7,435
55.05
212,520
15.80

Long-term care hospital
2,792
42.76
700
5.18
99,643
3.50

Western Clinic
710
10.87
868
6.42
78,343
13.69

Public Health Hospital
1
0.02
1
0.01
42,477
19.00

Total
6,316
96.74
13,383
99.08
158,039
10.69

Traditional
Traditional Hospital
190
2.91
114
0.84
62,827
12.07

Traditional Clinic
23
0.35
11
0.08
33,646
15.57

Total
213
3.26
125
0.92
59,676
12.45

Total

6,529
100.00
13,507
100.00
154,830
10.74

2013
Western
Tertiary Hospital
195
2.65
1,287
8.79
454,263
16.49

General Hospital
725
9.87
3,681
25.16
234,228
21.27

Hospital
1,997
27.18
7,678
52.49
215,432
16.46

Long-term care hospital
3,393
46.18
888
6.07
98,884
3.62

Western Clinic
774
10.53
939
6.42
84,784
12.97

Public Health Hospital
2
0.03
1
0.01
44,311
16.00

Total
7,086
96.45
14,474
98.95
153,802
10.42

Traditional
Traditional Hospital
234
3.18
140
0.96
64,218
11.45

Traditional Clinic
27
0.37
14
0.10
42,487
13.56

Total
261
3.55
154
1.05
61,970
11.67

Total

7,347
100.00
14,628
100.00
150,539
10.47

2014
Western
Tertiary Hospital
272
3.28
1,641
11.46
459,732
14.81

General Hospital
727
8.75
3,723
26.01
233,047
22.00

Hospital
2,152
25.92
6,911
48.29
205,374
14.52

Long-term care hospital
4,022
48.43
1,045
7.30
102,035
3.44

Western Clinic
766
9.22
783
5.47
75,945
13.00

Public Health Hospital
1
0.01
0
0.00
63,640
4.00

Total
7,940
95.62
14,103
98.54
151,771
9.46

Traditional
Traditional Hospital
329
3.96
193
1.35
64,804
11.00

Traditional Clinic
35
0.42
16
0.11
38,910
13.77

Total
364
4.38
209
1.46
62,314
11.26

Total

8,304
100.00
14,312
100.00
147,849
9.54

with overlapping records were tallied as one patient (overlap was not allowed). determined to be eligible for reimbursement by the HIRA (Health Insurance Review and Assessment Service) out of the total treatment amount were indicated in the submitted insurance claim statement. They are expressed as means and are in Korean Won (1,000,000 KRW). diem is the average daily cost of services covered by National Health Insurance. per episode are the total number of hospitalized days divided by the total number of hospitalizations.

Table 11: Number of outpatients with gonarthrosis [M17] by hospital type.

Year
Type of medicine
Hospital type
Frequency
Outpatient costs
LOS

%

%
Per
Days per

2011
Western
Tertiary Hospital
3,771
0.59
199
1.35
39,490
1.76

General Hospital
13,999
2.18
689
4.69
32,279
6.26

Hospital
28,259
4.39
1,667
11.33
28,169
2.04

Long-term care hospital
1,872
0.29
95
0.65
15,504
3.51

Clinic
458,027
71.23
9,641
65.55
21,049
1.02

Public Health Center
1,495
0.23
5
0.04
3,474
1.00

Local Public Health Clinic
389
0.06
5
0.03
12,991
7.70

Public Health Hospital
1,018
0.16
27
0.18
26,723
1.67

Total
508,830
79.13
12,329
83.83
21,823
1.24

Traditional
Traditional Hospital
1,022
0.16
49
0.33
16,099
2.81

Traditional Clinic
133,159
20.71
2,330
15.84
17,497
1.04

Total
134,181
20.87
2,379
16.17
17,486
1.05

Total

643,011
100.00
14,707
100.00
20,918
1.20

2012
Western
Tertiary Hospital
4,817
0.71
215
1.42
44,547
1.55

General Hospital
20,949
3.10
720
4.76
34,367
4.58

Hospital
54,982
8.13
1,858
12.27
33,789
1.12

Long-term care hospital
4,519
0.67
99
0.66
22,003
1.42

Clinic
448,226
66.29
9,691
64.01
21,621
1.02

Public Health Center
1,592
0.00
6
0.00
3,811
1.01

Local Public Health Clinic
439
0.24
3
0.04
7,361
4.12

Public Health Hospital
855
0.06
26
0.02
30,431
1.46

Dental Hospital
2
0.13
0
0.17
24,970
1.00

Total
536,381
79.33
12,618
83.34
23,525
1.18

Traditional
Traditional Hospital
2,332
0.34
50
0.33
21,369
1.16

Traditional Clinic
137,458
20.33
2,472
16.33
17,986
1.03

Total
139,790
20.67
2,522
16.66
18,042
1.03

Total

676,171
100.00
15,140
100.00
22,391
1.15

2013
Western
Tertiary Hospital
4,949
0.72
218
1.37
44,048
1.57

General Hospital
21,512
3.12
783
4.92
36,416
4.20

Hospital
55,199
7.99
1,879
11.81
34,034
1.12

Long-term care hospital
4,780
0.69
104
0.66
21,854
1.49

Clinic
456,160
66.06
10,203
64.13
22,367
1.01

Public Health Center
1,678
0.24
6
0.04
3,442
1.05

Local Public Health Clinic
191
0.03
2
0.02
12,633
6.90

Public Health Hospital
692
0.10
23
0.15
33,579
1.97

Total
545,161
78.94
13,219
83.09
24,248
1.16

Traditional
Traditional Hospital
2,306
0.33
52
0.32
22,375
1.13

Traditional Clinic
143,105
20.72
2,639
16.59
18,443
1.03

Total
145,411
21.06
2,691
16.91
18,505
1.03

Total

690,572
100.00
15,910
100.00
23,039
1.14

2014
Western
Tertiary Hospital
5,377
0.77
243
1.43
45,133
1.24

General Hospital
22,999
3.30
856
5.06
37,234
3.85

Hospital
57,441
8.23
1,986
11.74
34,571
1.11

Long-term care hospital
4,748
0.68
106
0.63
22,320
1.48

Clinic
461,684
66.18
10,962
64.81
23,742
1.01

Public Health Center
2,372
0.00
8
0.00
3,298
1.00

Local Public Health Clinic
171
0.34
2
0.05
12,230
6.67

Public Health Hospital
732
0.02
21
0.01
28,470
1.31

Dental Hospital
11
0.10
0
0.12
18,469
1.00

Total
555,535
79.63
14,183
83.86
25,531
1.15

Traditional
Traditional Hospital
2,516
0.36
59
0.35
23,541
1.13

Traditional Clinic
139,576
20.01
2,670
15.79
19,127
1.03

Total
142,092
20.37
2,729
16.14
19,205
1.03

Total

697,627
100.00
16,912
100.00
24,242
1.12

with overlapping records were tallied as one patient (overlap was not allowed). determined to be eligible for reimbursement by the HIRA (Health Insurance Review and Assessment Service) out of the total treatment amount were indicated in the submitted insurance claim statement. They is expressed as a mean and are in Korean Won (1,000,000 KRW). diem is the average daily cost of services covered by National Health Insurance. per episode are the total number of outpatient visit days including drug prescription days divided by the total number of outpatient visits.

Table 12: Number of hospitalizations for shoulder lesion [M75] patients by hospital type.

Year
Type of medicine
Hospital type
Frequency
Hospitalization costs
LOS

%

%
Per
Days per

2011
Western
Tertiary Hospital
135
5.54
278
9.55
377,378
6.08

General Hospital
381
15.62
765
26.31
210,523
12.83

Hospital
1,101
45.14
1,608
55.27
203,071
8.86

Long-term care hospital
589
24.15
69
2.37
94,749
1.45

Western Clinic
193
7.91
167
5.74
99,580
11.10

Total
2,399
98.36
2,886
99.24
179,142
7.69

Traditional
Traditional Hospital
39
1.6
22
0.75
53203
14.26

Traditional Clinic
1
0.04
0
0.01
21440
14

Total
40
1.64
22
0.76
52409
14.25

Total

2,439
100.00
2,908
100.00
177,064
7.80

2012
Western
Tertiary Hospital
142
4.53
318
8.32
374,833
6.37

General Hospital
468
14.92
989
25.85
208,846
12.43

Hospital
1,547
49.33
2,168
56.66
200,108
8.36

Long-term care hospital
661
21.08
75
1.96
98,519
1.25

Western Clinic
252
8.04
242
6.33
138,525
9.81

Total
3,070
97.90
3,792
99.13
182,594
7.48

Traditional
Traditional Hospital
62
1.98
32
0.84
58,945
11.53

Traditional Clinic
4
0.13
1
0.03
31,056
14.25

Total
66
2.10
33
0.87
57,255
11.70

Total

3,136
100.00
3,826
100.00
179,956
7.57

2013
Western
Tertiary Hospital
169
4.50
388
8.65
379,396
6.41

General Hospital
582
15.48
1,212
27.01
188,152
13.07

Hospital
1,920
51.08
2,524
56.27
193,851
7.58

Long-term care hospital
739
19.66
100
2.22
95,331
1.68

Western Clinic
274
7.29
223
4.97
156,193
8.29

Public Health Hospital
1
0.03
0
0.00
89,370
1.00

Total
3,685
98.03
4,446
99.12
178,875
7.26

Traditional
Traditional Hospital
68
1.81
37
0.82
64,497
10.57

Traditional Clinic
6
0.16
3
0.06
40,844
14.17

Total
74
1.97
40
0.88
62,579
10.86

Total

3,759
100.00
4,485
100.00
176,585
7.33

2014
Western
Tertiary Hospital
161
3.70
333
6.97
377,875
5.68

General Hospital
671
15.42
1,214
25.45
202,746
10.41

Hospital
2,298
52.80
2,773
58.12
188,633
6.86

Long-term care hospital
817
18.77
134
2.80
99,291
2.07

Western Clinic
323
7.42
276
5.79
164,902
8.50

Total
4,270
98.12
4,730
99.12
179,097
6.58

Traditional
Traditional Hospital
76
1.75
39
0.83
60,405
10.09

Traditional Clinic
6
0.14
2
0.05
23,633
17.17

Total
82
1.88
42
0.88
57,714
10.61

Total

4,352
100.00
4,772
100.00
176,810
6.66

with overlapping records were tallied as one patient (overlap not allowed). determined to be eligible for reimbursement by the HIRA (Health Insurance Review and Assessment Service) out of the total treatment amount were indicated in the submitted insurance claim statement. They are expressed as means and are in Korean Won (1,000,000 KRW). diem is the average daily cost of services covered by National Health Insurance. per episode are the total number of hospitalized days divided by the total number of hospitalizations.

Table 13: Number of outpatients with shoulder lesions [M75] by hospital type.

Year
Type of medicine
Hospital type
Frequency
Outpatient costs
LOS

%

%
Per
Days per

2011
Western
Tertiary Hospital
3,279
0.74
147
1.55
29,079
2.14

General Hospital
8,754
1.97
420
4.42
26,730
4.09

Hospital
16,434
3.70
803
8.45
21,712
2.21

Long-term care hospital
1,120
0.25
47
0.50
16,906
2.84

Clinic
228,892
51.48
4,559
47.99
19,916
1.01

Dental Hospital
8
0.00
0
0.00
18,765
1.63

Public Health Center
301
0.07
1
0.01
3,204
1.00

Local Public Health Clinic
22
0.00
0
0.00
5,281
1.91

Public Health Hospital
126
0.03
3
0.03
23,603
1.25

Total
258,936
58.24
5,980
62.96
20,345
1.21

Traditional
Traditional Hospital
1,327
0.30
62
0.66
17,637
2.58

Traditional Clinic
184,372
41.47
3,456
36.39
18,746
1.04

Total
185,699
41.76
3,519
37.04
18,738
1.05

Total

444,635
100.00
9,499
100.00
19,674
1.14

2012
Western
Tertiary Hospital
4,805
1.03
150
1.54
31,203
1.33

General Hospital
16,148
3.45
418
4.29
25,911
2.07

Hospital
42,956
9.18
1,004
10.29
23,362
1.05

Long-term care hospital
2,372
0.51
52
0.53
21,931
1.40

Clinic
230,518
49.28
4,790
49.14
20,780
1.01

Dental Hospital
5
0.00
0
0.00
26,800
1.00

Public Health Center
552
0.12
2
0.02
3,290
1.00

Local Public Health Clinic
12
0.00
0
0.00
9,058
3.92

Public Health Hospital
168
0.04
4
0.04
22,856
3.33

Total
297,536
63.60
6,420
65.85
21,577
1.08

Traditional
Traditional Hospital
2,348
0.50
52
0.53
22,053
1.31

Traditional Clinic
167,911
35.89
3,277
33.62
19,517
1.03

Total
170,259
36.40
3,329
34.15
19,552
1.04

Total

467,795
100.00
9,749
100.00
20,840
1.07

2013
Western
Tertiary Hospital
5,053
1.07
167
1.63
33,032
1.29

General Hospital
15,611
3.31
434
4.26
27,831
2.06

Hospital
46,514
9.86
1,108
10.85
23,823
1.05

Long-term care hospital
2,105
0.45
49
0.48
23,288
1.45

Clinic
234,099
49.61
5,077
49.73
21,688
1.01

Dental Hospital
6
0.00
0
0.00
17,590
1.00

Public Health Center
701
0.15
2
0.02
2,487
1.00

Local Public Health Clinic
24
0.01
0
0.00
6,914
2.96

Public Health Hospital
132
0.03
3
0.03
25,864
1.74

Total
304,245
64.47
6,841
67.01
22,486
1.08

Traditional
Traditional Hospital
2,163
0.46
51
0.50
23,727
1.09

Traditional Clinic
165,476
35.07
3,317
32.49
20,047
1.03

Total
167,639
35.53
3,369
32.99
20,095
1.03

Total

471,884
100.00
10,210
100.00
21,636
1.06

2014
Western
Tertiary Hospital
4,474
0.96
149
1.42
33,281
1.34

General Hospital
17,733
3.82
502
4.79
28,320
2.11

Hospital
48,171
10.38
1,136
10.85
23,590
1.04

Long-term care hospital
2,106
0.45
50
0.47
23,507
1.36

Clinic
232,309
50.07
5,315
50.74
22,881
1.01

Public Health Center
471
0.10
2
0.02
3,848
1.37

Local Public Health Clinic
35
0.01
0
0.00
7,430
3.80

Public Health Hospital
211
0.05
6
0.06
28,187
1.34

Total
305,510
65.84
7,160
68.35
23,437
1.09

Traditional
Traditional Hospital
3,330
33.44
73
30.96
21,781
1.03

Traditional Clinic
155,153
0.72
3,243
0.69
20,903
1.03

Total
158,483
34.16
3,316
31.65
20,921
1.03

Total

463,993
100.00
10,476
100.00
22,578
1.07

with overlapping records were tallied as one patient (overlap was not allowed). determined to be eligible for reimbursement by the HIRA (Health Insurance Review and Assessment Service) out of the total treatment amount were indicated in the submitted insurance claim statement. They are expressed as means and are in Korean Won (1,000,000 KRW). diem is the average daily cost of services covered by National Health Insurance. per episode are the total number of outpatient visit days including drug prescription days divided by the total number of outpatient visits.

Table 14: Number of hospitalizations for wrist and hand level lesions [S63] by hospital type.

Year
Type of medicine
Hospital type
Frequency
Hospitalization costs
LOS

%

%
Per
Days per

2011
Western
Tertiary Hospital
11
4.98
13
7.68
278,227
5.45

General Hospital
45
20.36
43
25.65
179,511
6.20

Hospital
97
43.89
74
44.40
139,886
6.36

Long-term care hospital
11
4.98
1
0.84
61,642
2.18

Western Clinic
52
23.53
34
20.56
82,895
9.83

Total
216
97.74
165
99.13
137,482
6.90

Traditional
Traditional Hospital
4
1.81
1
0.59
50,891
4.75

Traditional Clinic
1
0.45
0
0.28
32,616
14.00

Total
5
2.26
1
0.87
47,236
6.60

Total

221
100.00
166
100.00
135,440
6.90

2012
Western
Tertiary Hospital
9
4.31
10
6.32
248,187
4.89

General Hospital
32
15.31
31
20.03
181,560
8.19

Hospital
112
53.59
87
55.96
127,213
7.51

Long-term care hospital
13
6.22
1
0.83
99,160
1.00

Western Clinic
38
18.18
25
15.80
91,169
9.32

Total
204
97.61
154
98.93
132,573
7.42

Traditional
Traditional Hospital
2
0.96
1
0.61
53,661
8.00

Traditional Clinic
3
1.44
1
0.46
41,900
7.33

Total
5
2.39
2
1.07
46,604
7.60

Total

209
100.00
156
100.00
130,517
7.43

2013
Western
Tertiary Hospital
11
4.12
13
7.25
342,630
3.73

General Hospital
50
18.73
47
26.27
156,802
6.76

Hospital
111
41.57
85
46.85
130,977
6.95

Long-term care hospital
44
16.48
4
1.98
80,871
1.09

Western Clinic
47
17.60
30
16.67
88,549
10.30

Total
263
98.50
179
99.03
128,774
6.40

Traditional
Traditional Hospital
4
1.50
2
0.97
53,481
8.00

Total
4
1.50
2
0.97
53,481
8.00

Total

267
100.00
180
100.00
127,646
6.42

2014
Western
Tertiary Hospital
13
5.06
12
5.82
210,379
4.00

General Hospital
65
25.29
71
33.81
167,548
8.48

Hospital
118
45.91
97
46.30
137,949
6.69

Long-term care hospital
14
5.45
1
0.54
81,609
1.00

Western Clinic
43
16.73
27
12.62
88,134
8.91

Total
253
98.44
208
99.08
137,691
7.08

Traditional
Traditional Hospital
3
1.17
1
0.59
64,672
8.00

Traditional Clinic
1
0.39
1
0.33
36,168
19.00

Total
4
1.56
2
0.92
57,546
10.75

Total

257
100.00
210
100.00
136,444
7.13

with overlapping records were tallied as one patient (overlap was not allowed). determined to be eligible for reimbursement by the HIRA (Health Insurance Review and Assessment Service) out of the total treatment amount were indicated in the submitted insurance claim statement. They are expressed as means and are in Korean Won (1,000,000 KRW). diem is the average daily cost of services covered by National Health Insurance. per episode are the total number of hospitalized days divided by the total number of hospitalizations.

Table 15: Number of outpatients for wrist and hand level lesions [S63] by hospital type.

Year
Type of medicine
Hospital type
Frequency
Outpatient costs
LOS

%

%
Per
Days per

2011
Western
Tertiary Hospital
251
0.18
19
0.60
58,745
1.58

General Hospital
2,612
1.91
155
4.95
44,742
1.62

Hospital
7,082
5.18
319
10.18
29,974
1.58

Long-term care hospital
321
0.23
12
0.37
18,678
1.99

Clinic
73,276
53.59
1,618
51.67
22,082
1.00

Public Health Center
39
0.03
0
0.01
5,699
1.00

Local Public Health Clinic
13
0.01
0
0.01
18,520
11.46

Public Health Hospital
30
0.02
1
0.02
18,767
1.23

Total
83,624
61.16
2,124
67.81
23,546
1.08

Traditional
Traditional Hospital
545
0.40
21
0.68
18,048
2.18

Traditional Clinic
52,561
38.44
987
31.51
18,777
1.03

Total
53,106
38.84
1,008
32.19
18,770
1.04

Total

136,730
100.00
3,132
100.00
21,691
1.06

2012
Western
Tertiary Hospital
306
0.21
16
0.48
51,987
1.36

General Hospital
3,404
2.37
146
4.41
42,810
1.19

Hospital
11,477
7.98
357
10.80
31,071
1.04

Long-term care hospital
667
0.46
13
0.40
19,954
1.10

Clinic
72,525
50.42
1,680
50.86
23,163
1.01

Public Health Center
1
0.00
0
0.00
5,790
1.00

Local Public Health Clinic
13
0.01
0
0.00
8,726
4.00

Public Health Hospital
46
0.03
1
0.04
29,252
1.43

Total
88,439
61.49
2,213
66.99
25,022
1.02

Traditional
Traditional Hospital
838
0.58
18
0.53
20,947
1.05

Traditional Clinic
54,556
37.93
1,073
32.48
19,664
1.02

Total
55,394
38.51
1,090
33.01
19,683
1.02

Total

143,833
100.00
3,303
100.00
22,966
1.02

2013
Western
Tertiary Hospital
297
0.20
19
0.54
65,123
1.40

General Hospital
3,512
2.34
163
4.58
46,354
1.19

Hospital
10,971
7.30
360
10.13
32,801
1.07

Long-term care hospital
484
0.32
10
0.28
20,811
1.07

Clinic
74,188
49.34
1,758
49.50
23,690
1.00

Public Health Center
34
0.00
0
0.00
3,086
1.00

Local Public Health Clinic
7
0.02
0
0.00
7,674
3.00

Public Health Hospital
52
0.00
1
0.00
24,083
1.23

Dental Hospital
1
0.03
0
0.04
24,540
1.00

Total
89,546
59.56
2,311
65.09
25,808
1.02

Traditional
Traditional Hospital
956
0.64
22
0.62
22,855
1.05

Traditional Clinic
59,845
39.80
1,218
34.30
20,350
1.02

Total
60,801
40.44
1,240
34.91
20,390
1.02

Total

150,347
100.00
3,551
100.00
23,617
1.02

2014
Western
Tertiary Hospital
332
0.22
21
0.57
63,661
1.34

General Hospital
3,886
2.55
180
4.80
46,221
1.44

Hospital
11,366
7.47
372
9.96
32,755
1.05

Long-term care hospital
646
0.42
14
0.38
21,995
1.20

Clinic
75,535
49.66
1,868
49.94
24,725
1.00

Public Health Center
10
0.00
0
0.00
4,050
1.00

Local Public Health Clinic
14
0.01
0
0.00
8,487
3.43

Public Health Hospital
50
0.01
1
0.00
24,903
1.18

Dental Hospital
4
0.03
0
0.03
19,768
1.00

Total
91,843
60.39
2,456
65.69
26,745
1.03

Traditional
Traditional Hospital
892
0.59
20
0.55
22,893
1.08

Traditional Clinic
59,360
39.03
1,263
33.77
21,273
1.02

Total
60,252
39.61
1,283
34.31
21,297
1.02

Total

152,095
100.00
3,740
100.00
24,587
1.03

with overlapping records were tallied as one patient (overlap was not allowed). determined to be eligible for reimbursement by the HIRA (Health Insurance Review and Assessment Service) out of the total treatment amount were indicated in the submitted insurance claim statement. They are expressed as means and are in Korean Won (1,000,000 KRW). diem is the average daily cost of services covered by National Health Insurance. per episode are the total number of outpatient visit days including drug prescription days divided by the total number of outpatient visits.

Table 16: Number of hospitalizations for ankle and foot level lesions [S93] by hospital type.

Year
Type of medicine
Hospital type
Frequency
Hospitalization costs
LOS

%

%
Per
Days per

2011
Western
Tertiary Hospital
5
0.55
8
1.24
173,270
10.40

General Hospital
108
11.91
123
18.23
98,380
12.77

Hospital
345
38.04
280
41.41
84,468
10.59

Long-term care hospital
34
3.75
6
0.96
65,373
3.26

Western Clinic
368
40.57
241
35.54
56,559
12.45

Total
860
94.82
659
97.38
74,034
11.37

Traditional
Traditional Hospital
42
4.63
17
2.47
49,012
9.38

Traditional Clinic
5
0.55
1
0.15
34,441
6.80

Total
47
5.18
18
2.62
47,462
9.11

Total

907
100.00
677
100.00
72,657
11.25

2012
Western
Tertiary Hospital
10
0.99
12
1.61
193,439
6.00

General Hospital
148
14.70
156
20.70
108,791
11.49

Hospital
391
38.83
305
40.51
88,346
9.74

Long-term care hospital
38
3.77
12
1.61
82,398
5.34

Western Clinic
383
38.03
250
33.20
59,570
11.50

Total
970
96.33
734
97.63
80,954
10.49

Traditional
Traditional Hospital
32
3.18
16
2.17
46,740
12.50

Traditional Clinic
5
0.50
2
0.20
32,100
9.80

Total
37
3.67
18
2.37
44,761
12.14

Total

1,007
100.00
752
100.00
79,624
10.55

2013
Western
Tertiary Hospital
8
0.68
13
1.41
206,721
7.75

General Hospital
186
15.74
192
21.49
117,806
9.83

Hospital
465
39.34
390
43.78
104,115
8.94

Long-term care hospital
61
5.16
14
1.57
93,890
3.52

Western Clinic
398
33.67
262
29.42
64,569
11.39

Total
1,118
94.59
871
97.67
92,491
9.65

Traditional
Traditional Hospital
60
5.08
20
2.23
66,044
6.93

Traditional Clinic
4
0.34
1
0.11
22,968
11.50

Total
64
5.41
21
2.33
63,352
7.22

Total

1,182
100.00
891
100.00
90,913
9.52

2014
Western
Tertiary Hospital
9
0.66
10
0.92
200,250
6.00

General Hospital
214
15.65
234
22.08
127,396
10.31

Hospital
625
45.72
533
50.31
105,591
8.72

Long-term care hospital
72
5.27
24
2.27
92,879
5.67

Western Clinic
376
27.51
235
22.22
63,569
10.69

Total
1,296
94.81
1,036
97.81
96,951
9.36

Traditional
Traditional Hospital
61
4.46
20
1.90
58,725
7.28

Traditional Clinic
10
0.73
3
0.29
25,945
12.80

Total
71
5.19
23
2.19
54,108
8.06

Total

1,367
100.00
1,059
100.00
94,726
9.30

atients with overlapping records were tallied as one patient (overlap not allowed). determined to be eligible for reimbursement by the HIRA (Health Insurance Review and Assessment Service) out of the total treatment amount were indicated in the submitted insurance claim statement. They are expressed as means and are in Korean Won (1,000,000 KRW). diem is the average daily cost of services covered by National Health Insurance. per episode are the total number of hospitalized days divided by the total number of hospitalizations.

Table 17: Number of outpatient visits for ankle and foot level lesions [S93] by hospital type.

Year
Type of medicine
Hospital type
Frequency
Outpatient costs
LOS

%

%
Per
Days per

2011
Western
Tertiary Hospital
559
0.23
46
0.79
71,456
1.84

General Hospital
4,204
1.69
285
4.88
54,910
1.60

Hospital
10,466
4.22
571
9.77
35,586
1.69

Long-term care hospital
465
0.19
18
0.31
23,088
1.90

Clinic
107,340
43.28
2,471
42.30
23,025
1.00

Dental Hospital
6
0.00
0
0.01
16,350
2.67

Public Health Center
10
0.00
0
0.00
3,012
1.00

Local Public Health Clinic
18
0.01
0
0.00
7,036
2.56

Public Health Hospital
79
0.03
2
0.04
31,605
1.52

Total
123,147
49.65
3,395
58.10
25,402
1.09

Traditional
Traditional Hospital
1,141
0.46
45
0.78
18,915
2.03

Traditional Clinic
123,750
49.89
2,403
41.12
19,416
1.03

Total
124,891
50.35
2,448
41.90
19,412
1.04

Total

248,038
100.00
5,843
100.00
22,386
1.06

2012
Western
Tertiary Hospital
769
0.30
50
0.80
64,899
1.51

General Hospital
5,806
2.23
310
5.00
53,426
1.27

Hospital
17,632
6.76
625
10.07
35,457
1.06

Long-term care hospital
903
0.35
19
0.31
21,587
1.12

Clinic
107,284
41.16
2,589
41.71
24,132
1.00

Dental Hospital
31
0.01
1
0.01
26,883
1.00

Public Health Center
14
0.01
0
0.00
4,871
1.00

Local Public Health Clinic
23
0.01
0
0.00
9,318
4.30

Public Health Hospital
82
0.03
3
0.04
31,415
1.39

Total
132,544
50.85
3,597
57.96
27,142
1.03

Traditional
Traditional Hospital
2,414
0.93
54
0.86
22,190
1.06

Traditional Clinic
125,678
48.22
2,556
41.18
20,336
1.03

Total
128,092
49.15
2,609
42.04
20,371
1.03

Total

260,636
100.00
6,207
100.00
23,814
1.03

2013
Western
Tertiary Hospital
752
0.28
50
0.76
66,703
1.68

General Hospital
6,417
2.39
357
5.40
55,586
1.22

Hospital
18,960
7.05
675
10.22
35,603
1.05

Long-term care hospital
773
0.29
17
0.25
21,454
1.10

Clinic
109,956
40.91
2,731
41.35
24,835
1.00

Dental Hospital
4
0.00
0
0.00
25,545
1.00

Public Health Center
28
0.01
0
0.00
2,908
1.00

Local Public Health Clinic
23
0.01
0
0.00
6,697
2.83

Public Health Hospital
70
0.03
2
0.03
30,855
1.23

Total
136,983
50.96
3,832
58.02
27,972
1.02

Traditional
Traditional Hospital
2,255
0.84
52
0.79
23,228
1.05

Traditional Clinic
129,546
48.20
2,720
41.18
20,994
1.02

Total
131,801
49.04
2,772
41.98
21,032
1.02

Total

268,784
100.00
6,604
100.00
24,569
1.02

2014
Western
Tertiary Hospital
634
0.23
53
0.76
83,468
1.66

General Hospital
7,410
2.72
415
5.95
56,052
1.27

Hospital
19,690
7.24
715
10.25
36,321
1.05

Long-term care hospital
747
0.27
17
0.25
23,249
1.08

Clinic
111,528
41.01
2,884
41.34
25,857
1.00

Dental Hospital
3
0.00
0
0.00
19,330
1.00

Public Health Center
12
0.00
0
0.00
4,125
1.00

Local Public Health Clinic
16
0.01
0
0.00
10,259
4.63

Public Health Hospital
67
0.02
2
0.03
28,492
1.03

Total
140,107
51.52
4,087
58.58
29,169
1.03

Traditional
Traditional Hospital
2,080
0.76
51
0.73
24,517
1.04

Traditional Clinic
129,744
47.71
2,839
40.69
21,880
1.02

Total
131,824
48.48
2,890
41.42
21,922
1.02

Total

271,931
100.00
6,977
100.00
25,656
1.03

with overlapping records were tallied as one patient (overlap not allowed). determined to be eligible for reimbursement by the HIRA (Health Insurance Review and Assessment Service) out of the total treatment amount were indicated in the submitted insurance claim statement. They are expressed as means and are in Korean Won (1,000,000 KRW). diem is the average daily cost of services covered by National Health Insurance. per episode are the total number of outpatient visit days including drug prescription days divided by the total number of outpatient visits.

Table 18: Distribution of nonsurgical interventions in Western medicine and traditional Korean medicine.

Nonsurgical intervention
Total
Year
2011
2012
2013
2014

1,481,969
1,560,032
1,594,949
1,600,774

WM
Basic physical
0

947,982
1,000,863
1,034,024
1,033,566

%
(63.97)
(64.16)
(64.83)
(64.57)

1

32,582
38,311
46,856
45,063

%
(2.20)
(2.46)
(2.94)
(2.82)

2

136,773
137,871
126,126
122,500

%
(9.23)
(8.84)
(7.91)
(7.65)

3≦
N
364,632
382,987
387,943
399,645

(24.60)
(24.55)
(24.32)
(24.97)

WM
Simple
0

1,475,271
1,551,724
1,585,834
1,590,708

%
(99.55)
(99.47)
(99.43)
(99.37)

1≦

6,698
8,308
9,115
10,066

%
(.45)
(.53)
(.57)
(.63)

WM
Professional
0

1,481,873
1,560,008
1,594,914
1,600,736

%
(99.99)
(100.00)
(100.00)
(100.00)

1≦

96
24
35
38

%
(.01)
(.00)
(.00)
(.00)

WM
Rehabilitation of CNS
0

1,481,962
1,560,029
1,594,942
1,600,773

%
(100.00)
(100.00)
(100.00)
(100.00)

1≦

7
3
7
1

%
(.00)
(.00)
(.00)
(.00)

TM
Acupuncture
0

982,471
1,062,109
1,085,224
1,102,972

%
(66.29)
(68.08)
(68.04)
(68.90)

1

40,678
44,984
55,124
50,447

%
(2.74)
(2.88)
(3.46)
(3.15)

2≦

458,820
452,939
454,601
447,355

%
(30.96)
(29.03)
(28.50)
(27.95)

TM
Moxibustion
0

1,481,922
1,559,985
1,594,876
1,600,667

%
(100.00)
(100.00)
(100.00)
(99.99)

1≦

47
47
73
107

%
(.00)
(.00)
(.00)
(.01)

TM
Cupping
0

1,481,712
1,559,844
1,594,897
1,600,518

%
(99.98)
(99.99)
(100.00)
(99.98)

1≦

257
188
52
256

%
(.02)
(.01)
(.00)
(.02)

TM
Heat & cold therapy
0

1,481,856
1,559,985
1,594,897
1,600,734

%
(99.99)
(100.00)
(100.00)
(100.00)

1≦

113
47
52
40

%
(.01)
(.00)
(.00)
(.00)

patient could be hospitalized more than once during the study period, resulting in more than one claim per patient. Thus, the number of claims in the study was higher than the number of patients. physical therapy included superficial heat therapy, cold therapy, deep heat therapy, ultraviolet irradiation, transcutaneous electrical nerve stimulation, massage therapy, and simple therapeutic exercise. rehabilitation included paraffin bath, hydrotherapy, intermittent traction therapy, electrical stimulation therapy, laser therapy, therapeutic exercise, motor point block, pneumatic compression, complex decongestive physical therapy, and iontophoresis. rehabilitation included pool therapy, occupational therapy, activities of daily living training, neurogenic bladder training, functional electrical stimulation therapy, myofascial trigger point injection, rehabilitative social work, rehabilitative breathing therapy, rehabilitative functional training, and rehabilitative dysphagia therapy. WM, Western medicine; TM, traditional Korean medicine.

4. Discussion

This study assessed the prevalence and costs of most frequently used treatments for joint disorders in Korea to provide basic information for future usual care guidelines that may reduce health expenditures and help solve National Health Insurance deficits. This study used the 2011–2014 HIRA-NPS data consisting of 3% age-stratified and gender-stratified random samples. It appropriately reflected the South Korean population of 2011–2014 to capture real-world medical use and cost in joint disorders.

The results of the study showed that the proportion of female patients was higher compared to that of male patients. This is consistent with previous findings showing that women are more likely to utilize health care than men [23, 24]. This might be due to gender role differences such as occupation, hours of work, and occupational activities including housework and biological factors. Women are typically responsible for childcare and housework while men are typically expected to have a job [25].

The shoulder and knee joints accounted for the most hospital visits and increased steeply. In Korea, musculoskeletal disease accounted for 28.2% of National Health Insurance Corporation (NHIC) inpatient and outpatient claims. Knee joint disease has been ranked the 6th among reasons for inpatient care visit and the 5th among reasons for outpatient care visit among the population aged 65 years or older [26]. The incidence of gonarthrosis has been steadily increasing in Korea. Its rate in women was much higher than that in men [27].

While Western Clinics were the most frequently visited medical institution type between 2011 and 2014, the finding that Traditional Clinics were the next most frequently visited in this study was noteworthy. The Korean medical system is characterized by both Western and traditional Korean medical practices. In 2014, the number of claims from Western medicine was 49,031 for Tertiary and General Hospitals and 16,935 for hospitals and clinics. On the contrary, the number of claims from traditional Korean medicine was 14,729 for hospitals and 7,690 for clinics [26]. These circumstances reflect the high proportion of traditional Korean medicine use for joint disorders [9]. Our results are consistent with previous results showing that Traditional Clinics are the second most visited institution by patients with nonspecific low back pain [14].

Despite the high demand for traditional Korean medicine for musculoskeletal diseases, traditional Korean medical practitioners are precluded from diagnosing joint disorders independently due to regulatory restrictions in imaging device use. We confirmed this fact again by comparing subgroup costs related to the type of medicine in total treatment cost. Apart from procedures such as acupuncture, moxibustion, and cupping, many treatments were not covered by the NHI (Table 7). Large variations in diagnostic and therapeutic management between Western medicine and traditional Korean medicine indicate that more items in Korean medicine need to be covered and developed. Among the hospitalized patients, the number of claims for all years after 2011 increased mostly for shoulder joints (78.43%) compared to 2011, followed by knees (61.93%), foot (50.72%), and hands (16.29%). While the rate of use of traditional Korean medicine for the shoulder region slightly decreased in outpatient care, the number of hospitalizations increased sharply (Table 9). It is interesting that the proportion of traditional hospitalization increase for the knee and shoulder regions (shoulder: 105.00%, knee: 250.00%) was higher than that of Western medicine clinic hospitalization (shoulder: 77.99%, knee: 58.04%). In Korea, the medical delivery system of traditional medicine is not strict. Individuals can choose to visit primary medical institutions (Traditional Clinic) and higher medical institutions (Traditional Hospital). Shoulder and knee joint diseases are common musculoskeletal diseases. They are usually treated in primary care settings. However, if there is no response or a lack of effectiveness in primary care, a Traditional Hospital is attended for a more accurate diagnosis and evaluation. This might be the reason why there is increase in hospitalization in Traditional Hospitals that hire orthodox medical practitioners who can use X-rays and magnetic resonance imaging. Besides, because traditional medical practitioners cannot use these examination devices in a Traditional Clinic, outpatient care in Traditional Clinics was much lower compared to that in Western Clinics. Although simple radiology is helpful in the diagnosis of joint disease [28], patient might suffer the inconvenience of going to both Western and Traditional Clinics for accurate diagnosis due to legal restrictions [29].

Traditional Korean medicine had lower medical expenditures than Western medicine (inpatient care cost: Western medicine clinic, 160,000 KRW; traditional Korean medicine clinic, 50,000 KRW; outpatient care cost: Western medicine, 22,000 KRW; traditional Korean medicine, 18,000 KRW). The average treatment cost for traditional Korean medicine was lower compared to that for Western medicine. RPE ranged from 181,225 KRW to 198,661 KRW for Western medicine and 82,019 KRW to 96,325 KRW for traditional Korean medicine. In addition, out-of-pocket expenses for Western medicine (44,240 KRW to 49,621 KRW) were higher than those of traditional Korean medicine (20,154 KRW to 22966 KRW). Although expenditures for traditional Korean medicine were significantly lower compared to those for Western medicine, daily cost amount showed no significant difference between the two depending on the year. These results are similar to those of a previous study [6].

Most patients had mild joint diseases (more than 70%) with CCI scores of 0 and underwent nonsurgical treatment. Regardless of disease type, the proportion of surgery was less than 1%. Therefore, traditional medical care can serve as an alternative to Western medical care. We found that the proportion of acupuncture was slightly higher than basic physical therapy (Table 18). However, further research is needed to confirm that traditional Korean medicine is cost-effective for managing joint diseases.

This study has several limitations. First, the study was descriptive in nature. It reported sociodemographic characteristics, procedures, medication, and average cost for treating joint disorders without addressing a specific hypothesis. Recently, research results have been utilized as basis for policies by utilizing health-related big data. However, there is a lack of data analyzing various patterns of traditional medical services [30]. Although there are studies that use NHI claims data, they are limited to a single year or disease range [8, 13]. This study is novel in that it compared the utilization of Western medicine and traditional Korean medicine for the treatment of joint disorders in Korea. We believe the current study would serve as a good reference for countries with similar medical systems as that of Korea and would be able to contribute to international literature. Further research is required, such as analysis of factors influencing the use or frequency of Korean traditional medicine using multivariate statistics.

Second, while fee-for-service for nationally covered health care service was comprehensively recorded in the claim database, nonreimbursable items such as traditional drugs did not generate billing data. In addition, we only calculated direct medical costs based on information in the claim database. In general, there are nonmedical costs such as transportation costs and lost productivity due to morbidity because joint diseases tend to be chronic. In addition, the costs did not uncover items based on claims data that only contained information about medical services provided under the NHI. If uncovered items were included, the costs for traditional Korean medicine might be higher than that of Western medicine. In a previous study [31] comparing Western and traditional Korean medicine users, it was found that the traditional Korean medicine user group paid significantly more medical expenses than the Western medicine user group. In a study on the determinants of traditional Korean medicine use based on panel data [32], the number of patients using traditional Korean medicine was significantly higher than those using Western medicine. This is because the insurance benefit for traditional Korean medicine is lower than that for Western medicine.

Third, we did not include essential factors influencing choice of medical practice, such as education level, income, residence, severity, and health-related risk factors (e.g., alcohol consumption, smoking, and exercise) [33]. Previous studies have shown that factors affecting the use of traditional Korean medicine are not related to education level or income level [34, 35], high education level [14], low education level [36, 37], and low or high-income level [32]. In previous studies, factors such as the use of a therapist [33], confidence in oriental medical institution [32], recognition of therapeutic effect [38], and coping attitude of the oriental medical treatment [39] have been found to be significant factors. Although these essential variables are important parameters in choosing hospitals, they were missed due to the nature of the claims data. To overcome the omission of disturbance variables, medical insurance type (NHI or Medicaid) and region of hospital were used as surrogates of income and residence in this study. In addition, we considered disease severity by using CCI because severity of disease might greatly affect hospital choice. The remaining factors have been judged due to their impacts on health care utilization. We believe that the direction of the analysis of this study will not change. Due to the limitation in data characteristics, these elements were not included in this study. Future studies considering these factors are needed to confirm our findings.

Finally, the accuracy of diagnoses has been an issue due to the nature of claims data collected with the purpose of reimbursing health care services and not for clinical purposes [18]. The accuracy of diagnosis in the KNHI claims data has been reported to be about 70% [40]. Moreover, the accuracy of disease classification has been reported to be higher for inpatients than for outpatients. It is higher for severe disorders than for common mild disorders. It is also higher in General Hospitals than in clinics [41]. Nonetheless, in the process of designing this study, physicians in current practice concurred that these codes were not clearly differentiated for diagnosis in actual clinical practice settings in Korea. Therefore, analysis was performed in primary and secondary diagnoses in accordance with the opinion that various issues should be taken into account (e.g., private insurance, medical care institution characteristics, and individual differences in physicians) in category division. In addition, primary and secondary diagnoses are generally used in conjunction [14]. Therefore, in defining medical care usage due to joint disease, we reviewed not only the major diagnosis code, but also secondary diagnosis code. Despite our efforts, the diagnosis accuracy for joint diseases in this study might be challenged.

Despite these limitations, our study has several strengths. First, we analyzed age-stratified and gender-stratified random samples of the KNHI claims database representing 98% of the South Korean population. Claims statements covered extensive information on health care interventions (e.g., treatment, procedures, diagnostic tests, and prescription drugs), diagnosis, NHI payment cost, beneficiaries’ out-of-pocket expenses, sociodemographic characteristics, and medical institutions, thus providing useful nationwide epidemiological data. Its representativeness, reliability, and validity have been confirmed previously [41]. However, there is a lack of data necessary to understand various consumption patterns and supply patterns of traditional medical services [30].

Second, there are studies in other countries that analyze the status of traditional Korean medicine utilization by using representative data source [30, 42–44]. Unlike most previous clinical studies whose duration was less than one year, we attempted to analyze the change over four years for joint diseases based on the type of medicine used (Western or traditional Korean medicine). Until now, no studies have reported national data on the management of joint disorders for 2011 to 2014. This study holds significance in that it is the first study that reports distinct differences in patterns of medical care use and costs between Western medicine and traditional Korean medicine.

An added strength of this study was that it provided patterns of complementary and alternative medicine treatment for joint disorders in Korea by covering traditional Korean medicine treatments as acupuncture, moxibustion, and cupping in the NHI.

Third, we constructed pilot medical episode data considering characteristics of health claim data for joint diseases. This can be used as a data processing technique to calculate basic dynamics information. Health insurance claim data were produced by physicians based on diagnosis at the first visit to the hospital. Related claim data were then produced, including the diagnosis code, the date of initiation of treatment (hospitalization or outpatient), and personal information (age, sex). To use epidemiological data, it is necessary to link the billing statement classified for administrative purposes to the same hospitalization case [45]. In this study, the same patient filed a billing statement with the same hospital in the same medical institution for inpatient care. The date was connected to one hospitalization case.

Our study has several policy implications. As disease structure can change from acute to chronic degenerative disease, interest in traditional medicine is increasing with aging. The main purpose of traditional medicine use in South Korea is to prevent disease and promote general health [10]. Though traditional medicine plays a substantial role in the Korean health care system, the annual number of health insurance claims from traditional Korean medicine institutions has stagnated and decreased since 2012 [46]. Medical use is affected by demographic, socioeconomic, and psychocultural factors. It has been reported that these factors can affect health care utilization by interactions between factors rather than independent factors [47, 48]. Therefore, it is important to grasp the current position of traditional Korean medicine in order to prepare policy and directives. Currently, difference in standards of practice underlies mistrust for traditional Korean medicine among Western medical practitioners [6]. To overcome conflicts among orthodox and traditional practitioners, we need an effective health care delivery system that encourages consultation for both Western and traditional Korean medicine with accessibility. Further discussion must be considered by providing consultation programs for other chronic diseases and joint diseases.

5. Conclusions

This study provided objective information about epidemiologic characteristics of patients with joint disorders treated with Western medicine and traditional Korean medicine. It provided an understanding about the recent status and trends. It will provide a basis for further expansion of traditional Korean medicine for patients with muscular disorders. Based on HIRA data, medical use for joint disorders showed significant difference between the groups. It provides basic information for future usual care guidelines linked to health policy and budget appropriation. Timely and accurate information is essential for policy-makers to make decisions. The results of our study will contribute to management decisions for musculoskeletal diseases involving joint disorders.

Abbreviations

HIRA: | Health Insurance Review & Assessment Services
NHIS: | National Health Insurance Sample
WM: | Western medicine
TM: | Traditional Korean medicine.

Additional Points

Availability of Data and Material. Datasets generated and/or analyzed in the current study are available from the HIRA-NPS repository. HIRA data are third-party data not owned by the authors. HIRA data are available upon visit or by mail upon direct, email, or fax submission of dataset request form and declaration of data use downloadable from the “HIRA” website: [http://opendata.hira.or.kr/op/opc/selectPatDataAplInfoView.do] and upon payment of the transfer of data request fee (300,000 KRW per dataset).

Ethical Approval

The HIRA Research Ethics Committee of South Korea approved the protocol of this study.

Disclosure

Written informed consent was not obtained from participants because only clinical records were used in this study based on national billing data submitted to HIRA. Patient information was anonymized and deidentified by HIRA prior to analysis in this study.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this article.

Authors’ Contributions

Soyoon Kim constructed study design, Sukjin Bae analyzed the data, and Boyoung Jung interpreted the results. Soyoon Kim was scientific advisor and directed this study. Boyoung Jung wrote the manuscript and performed the statistical analysis. All authors read and approved the final manuscript.

Acknowledgments

This study was supported by Research Institute of Korean Medicine Policy.

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