Editorial 2023-11-30

HIRA Research의 현황과 향후 편집 방향

HIRA Research 2023; 3(2): 125-129

Review Article 2023-11-30

국내 디지털치료기기 시장 활성화를 위한 정책 제언: 해외 주요국 제도 분석을 중심으로

The digital therapeutics market is predicted to grow rapidly due to several factors such as changes in the medical paradigm and coronavirus disease 2019 (COVID-19). The Ministry of Food and Drug Safety has approved two digital therapeutics in 2023. The Korean government is announcing many deregulation policies to revitalize the healthcare industry. However, specific governance, such as medical device industry policy and health insurance, is still needed. In addition, the government’s continuous support for the healthcare industry in Korea is necessary. Accordingly, we investigated regulatory trends pertaining to digital therapeutics in other countries. Through this study, implications for insurance design suitable for the attributes of digital therapeutics and raising awareness of such therapeutics were derived.

HIRA Research 2023; 3(2): 130-141

Review Article 2023-11-30

코로나바이러스감염증-19 대응을 위한 국가별 재정지원 방식 고찰: 의료기관에 대한 재정지원을 중심으로

Korea initially adopted a policy of universal hospitalization for all confirmed cases of coronavirus disease 2019 (COVID-19) irrespective of symptoms, to prevent the spread of coronavirus in the absence of vaccines and treatments. However, this approach led to a shortage of beds to accommodate patients with COVID-19. To address this shortage, the government compensated those medical institutions that provided beds. This study reviewed the compensation methods and levels in Korea and foreign countries during COVID-19 pandemic to create a sustainable financial support system for future infectious disease situations. The study results are as follows: (Korea) The mortality rate of patients with COVID-19 is about 0.1%, and total expenditure due to COVID-19 is about 22.7 trillion won. (Japan) The mortality rate of patients with COVID-19 is about 0.2%, and total expenditure due to COVID-19 is about 106 trillion won. (Germany) The mortality rate of patients with COVID-19 is about 0.4%, and total expenditure due to COVID-19 is about 72 trillion won. (Taiwan) The mortality rate of patients with COVID-19 is about 0.4%, and total expenditure due to COVID-19 is about 7.8 trillion won. Many experts worldwide predict the occurrence of a large-scale infectious disease like COVID-19 in near future. This study is expected to serve as evidence for creating a sustainable financial support system in the event of a future infectious disease situation.

HIRA Research 2023; 3(2): 142-154

Original Article 2023-11-30

소아청소년 복합만성질환자 수 및 진료비의 변화: 2011-2021년 건강보험청구자료 분석

Background: The number of children and adolescents has decreased by more than 3 million over the past 10 years. We analyzed changes in the number of children and adolescents with complex chronic conditions (CCCs) and their medical expenditures between 2011 and 2021.
Methods: We used National Health Insurance claims data of patients under the age of 20 from 2011 to 2021. CCCs were classified as pediatric CCCs by Feudtner et al. Patients who repeatedly utilize medical services due to CCCs were defined as patients who sought medical care twice or more within the past 3 years. Their sex, age, CCC categories, and the number of CCC categories were presented using descriptive analyses.
Results: The number of children and adolescents with CCCs increased from 345,320 (3.04%) in 2011 to 451,238 (5.33%) in 2021. Patients who repeatedly utilized medical services due to CCCs increased by 71,889 during the same period. The proportion of patients with two or more CCC categories increased from 35.80% in 2011 to 43.67% in 2021. In 2021, patients with other congenital or genetic defect were most common. Medical expenditures associated with CCCs increased from 475,654 million won (12.34%) in 2011 to 768,467 million won (19.11%) in 2021.
Conclusion: The number of patients with CCCs and their medical expenditures increased in Korea between 2011 and 2021. The results indicate that consistent national efforts are required to maintain the specialized pediatric care. Further studies are needed to identify pediatric patients who require specialized medical services through various methods.

HIRA Research 2023; 3(2): 155-170

Original Article 2023-11-30

3차병원 중환자실 내 전향적 감사와 피드백을 통한 항생제 사용 중재 효과

Background: The implementation of antibiotic stewardship program (ASP) has been encouraged in developed countries in response to increasing antibiotic resistance. However, the implementation of ASP has been limited owing to a lack of manpower and awareness. We aimed to analyze the effectiveness of prospective audit and feedback (PAF), one of the core strategies in ASP, by applying it to the intensive care units (ICUs).
Methods: In this study, we applied PAF to the neurological/surgical ICUs of a tertiary hospital starting from March 1, 2023, we compared the data of 6 months before (from September 2022 to February 2023) and after (from March 2023 to August 2023) the implementation to assess the difference in antimicrobial use density (AUD) and the acquisition rates of antibiotic-resistant bacteria. Furthermore, we surveyed the satisfaction of PAF using a questionnaire. PAF was conducted twice a week during rounds by the ASP team, which consisted of an infectious disease specialist and one assistant.
Results: Before and after the implementation of PAF, AUD showed a tendency to decrease in the classes of beta-lactam/beta-lactamase inhibitors, cephalosporins and glycopeptides, although the changes were not statistically significant. The acquisition rate of carbapenem-resistant Acinetobacter baumannii decreased slightly in the surgical ICU. Most participating interns and residents reported that PAF was clinically and educationally helpful in the survey.
Conclusion: Implementing PAF twice a week in the neurological/surgical ICUs could reduce antibiotic usage and the acquisition rates of some resistant bacteria.

HIRA Research 2023; 3(2): 171-181

Original Article 2023-11-30

국내 체중 감량 약물 사용 현황 : 자발적으로 온라인에 게시한 처방전 분석

Background: Multiple medications have been used for weight loss (WL); however, research on the regimens of WL treatment in Korea have been limited. This study aimed to characterize the medications prescribed for WL in real-world settings.
Methods: The study sample comprised WL prescriptions (Rxs) shared via a portal site for 1 year (from June 2022 to May 2023). WL drugs were classified into four categories: (1) on-label WL drugs; (2) off-label WL drugs; (3) medication-induced symptom management drugs; (4) dietary supplements and others. We calculated prescribing occurrence rates for each category and drugs. Further, we investigated the usage of off-label and psychotropic drug prescribing.
Results: The study sample included 66 Rxs consisting of 63 active ingredients. The average number of medications per Rxs was seven (range, 1–13). Acetaminophen/caffeine/(pseudo)ephedrine (59.1%) and topiramate (54.5%) were the most commonly used medicines. The most frequently prescribed drug regimen involved a combination of on-label WL, off-label WL, and medication-induced symptom management drugs.
Conclusion: Psychotropic appetite suppressants have been prescribed with unapproved WL drugs or psychotropic anti-anxiety/hypnotics. Further research is needed to provide evidence on drug combinations to ensure the safety of WL treatments.

HIRA Research 2023; 3(2): 182-195

Original Article 2023-11-30

우울증 환자의 퇴원 후 외래 방문 관련 요인

Background: Ensuring timely outpatient follow-up care after hospital discharge in patients with depression is critical for preventing suicide and relapse. This study aimed to identify patient factors associated with receiving outpatient follow-up care within 7 days of hospital discharge for patients with depression.
Methods: We conducted a cross-sectional study using the National Health Insurance Claims Database. This study included all patients with depression aged 18 years or older who were newly admitted to hospitals from January 1, 2017 to December 31, 2018. A generalized estimating equation was used to explore the association between receiving outpatient follow-up care within 7 days of hospital discharge and various factors, such as age, sex, insurance type, comorbidity, and previous outpatient care.
Results: Of the 15,018 patients included in the study, 60.2% were female, and 6,886 patients (45.9%) received outpatient follow-up care within 7 days after hospital discharge. Patients who were females and those with previous outpatient care experience were more likely to receive outpatient follow-up care (odds ratio [OR] 1.410, 95% confidence interval [CI] 1.317-1.511; OR 2.502, 95% CI 2.269-2.759; respectively). In contrast, older and medicaid patients were less likely to receive outpatient care within 7 days after discharge.
Conclusion: To prevent suicide and relapse, discharge planning interventions should be actively provided to vulnerable groups, such as older individuals, males, medicaid patients, and patients without previous outpatient care experience.

HIRA Research 2023; 3(2): 196-204

Original Article 2023-11-30

사회경제적 형태에 따른 치매 유병률 변화: 건강보험, 의료급여 대상자를 중심으로

Background: Dementia is a critical health concern in Korea as the population ages and lives longer. Socioeconomic disadvantages have been identified as a risk factor for dementia. Our study aimed to estimate the prevalence of dementia by socioeconomic status in Korea by analyzing hospital utilization rates.
Methods: We examined National Health Insurance claims data in the Health Insurance Review & Assessment Service (HIRA) from 2008 to 2016 and identified all dementia cases. We calculated crude age- and sex-standardized prevalence by socioeconomic status. Health insurance types (Medical Aid and National Health Insurance beneficiaries) were used as socioeconomic status indicators.
Results: The age- and sex-standardized prevalence for dementia by health insurance type consistently increased, which was prominent among patients aged ≥85 years from 2008 to 2016. Rate ratio of age- and sex-standardized prevalence in Medical Aid beneficiaries (904.1–1,793.3 per 100,000 individuals, from 2008 to 2016) was approximately three times higher than that in National Health Insurance beneficiaries (311.0–622.6). Among patients aged <60 years, rate ratio difference of the age- and sex-standardized prevalence was estimated at 15.4 times in 2008 (15.2 in National Health Insurance and 233.6 in Medical Aid) and 26.5 times in 2016 (21.4 in National Health Insurance and 565.8 in Medical Aid).
Conclusion: The rate ratio of age- and sex-standardized prevalence for dementia in Medical Aid beneficiaries was approximately three times higher than that in National Health Insurance beneficiaries from 2008 to 2016. Moreover, difference in prevalence of early onset dementia (<60 years of age) highly increased. Therefore, Korean healthcare policy must prioritize dementia prevention and treatment according to socioeconomic status (Medical Aid beneficiaries), specifically for early onset dementia.

HIRA Research 2023; 3(2): 205-212

Perspective 2023-11-30

항생제 사례로 살펴본 건강보험청구자료 분석 시 고려사항

The Health Insurance Review & Assessment Service (HIRA) collects and stores medical information of all citizens and medical institutions, including pharmaceutical claims data. Claims data including consultation notes and information about the medical institution are submitted to the HIRA by medical providers. Claims data have potential to offer a high quality for research, but various factors must be strongly considered in its analysis and interpretation. This study highlights various points to be considered while utilizing claims data. First, the time period between a claims review and loading of the data onto a data warehouse (DW) must be taken into account because over 99% of claims are available on DW for extraction after 5 months, according to an analysis of claims rate for pharmaceutical expenses. Second, over 50% of pharmaceutical claims data consists of reimbursable items, of which over 99% are antimicrobial medications. Accurate determination of the precise usage of nonreimbursable pharmaceuticals is limited to estimations based on the data on pharmaceutical supply declaration, which is only partially reported on claims statements as part of the comprehensive fees system. Finally, complete data on the use of pharmaceuticals during inpatient admission is unavailable. Due to the lack of requirement to input the administration time or to differentiate prescriptions on the day of discharge, it is difficult to accurately calculate the used amounts. These factors must be considered prior to analysis and interpretation of claims data from the HIRA. Hence, to ensure a higher research quality, we recommend considering these factors when conducting a claims data-based research.

HIRA Research 2023; 3(2): 213-221

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