Utilization Patterns of Korean Medicine: An Analysis of the National Health Insurance Cohort Database from 2002 to 2013

Abstract

Objectives:

Although Korean Medicine (KM) is an important part of the Korean healthcare system and plays a significant role in chronic and incurable diseases, there is insufficient information about KM utilization. The aim of the study was to identify KM utilization patterns using a national representative sample data.

Methods:

KM users aged 0–80 years and older from the nationally representative sample in the National Health Insurance Service–National Sample Cohort of 778,506 KM users between 2002 and 2013 (were analyzed. Annual changes in utilization patterns were analyzed by sex, nine age groups, five income levels, and numbers of visits and hospitalizations. Utilization patterns by the type of healthcare institution and the top 10 major diseases were studied.

Results:

Frequencies of KM use differed according to analyses of patients and claims. Women used KM 1.5 times more than did men. Patients in their 40s and 50s made up one third of KM users. In contrast to other studies, high-income groups used KM more than did low-income groups. More than 96% of ambulatory patients used mostly KM clinics, and more than 76% of inpatients used KM hospitals. Musculoskeletal disorders were the main disease treated, which conformed to the results of previous studies.

Conclusion:

The results suggest that women, people in their 40s and 50s, and people with a relatively high income use KM more often than other patients. Further comparison studies of both Western medicine in Korea and other countries should be conducted.

Introduction

The use of traditional and complementary medicine (TCM) is increasing worldwide because TCM therapies have several advantages.^1,2 TCM treatments are easy to access and require relatively low costs and technological effort compared with conventional medicine. Patients choose TCM treatments not only for chronic and incurable diseases but also for health management. In addition to historical empirical evidence, recent clinical and nonclinical studies support the safety and efficacy of TCM treatments.³ Therefore, TCM is considered an alternative to healthcare systems in various countries.⁴

Korean medicine (KM) is a form of traditional medicine developed on its own whole person–centered medicine system. Although KM shares its origins with Chinese and Japanese medicine, KM has unique characteristics and modalities, such as Sasang constitutional medicine, Saam acupuncture, and Chuna.^5,6 The services of KM include acupuncture, moxibustion, cupping, pharmacupuncture, and herbal medicine. According to a study in 2014, 27.9% of Koreans use KM.^7,8 Korea operates a healthcare system that includes both conventional Western medicine and KM.⁹ Korea started a mandatory social insurance system in 1977 and extended coverage to the entire nation in 1989. KM has been covered by the National Health Insurance (NHI) system since 1987.¹⁰ More than 97% of the population is covered by the Korea National Health Insurance Program (KNHIP), and the remaining 3% are covered by a medical aid program that is operated by the Korea National Health Insurance Service (KNHIS).¹¹ However, KM expenses accounted for only 3.9% of KNHIP costs and 2.3% of medical aid program costs according to the total NHI costs for 2013¹² because the KM services covered by NHI are restricted to diagnosis, 56 herbal medicinal extracts,¹³ acupuncture, and cupping. Most medication services (herbal medicine) are noncovered items.

Since 1987, the medical services of KM have been expanded quantitatively as well as qualitatively in the national system. Although previous studies have investigated the utilization patterns of KM, including practice patterns, methods of payment, and costs for the entire population, few studies have analyzed KM utilization patterns using national health insurance data.¹⁴ The third Korean medical use and consumption survey, conducted in 2015, did not fully explain KM users' characteristics because of a lack of representativeness of survey data, such as potential recall bias.

This study used a national sample cohort constructed from the National Health Information Database in the NHI system this database was recently constructed to meet an increasing request for public use and the application of the health insurance data recently.¹⁵

Materials and Methods

Data sources and data extraction

The KNHIS covers the entire population with the KNHIP and medical aid program; thus, the KNHIS includes all health insurance records in Korea.¹⁰ The National Health Insurance Service–National Sample Cohort 2002–2013 (NHIS–NSC 2002–2013) is a dynamic cohort constructed in 2013 from the KNHIP. Because it includes long-term observation data, NHIS–NSC can evaluate temporal relationships and causality.

A representative sample of approximately 1,000,000 people was extracted from the 2002 database using a stratified, simple random sampling method. This sampled database consisted of 1476 subsets stratified by sex (2 groups), age group (19 age groups), income level by subscriber type (industrial workers and self-employed; 20 groups), and medical aid (0 groups). Finally, 1,025,340 registrants were included in the database, which represents 2% of health insurance beneficiaries. A total of 778,506 patients (370,435 males and 408,071 females) who visited KM clinics or hospitals at least once were analyzed. All patients' personal information was anonymized.

Study variables

In the study, a KM user was defined as a patient who had at least one KM clinic or hospital visit. Patient ages were categorized into nine groups as follows: 0–9 years, 10–19 years, 20–29 years, 30–39 years, 40–49 years, 50–59 years, 60–69 years, 70–79 years, and 80 years or older. Regarding socioeconomic status, patients were classified with a well-defined monthly income into six categories according to income percentage as follows: the lowest income group (lowest 20%), the low-middle income group (lower 20%–40%-), the middle income group (lower 40%–60%), the middle-high income group (upper 20%–40%), and the high income group (upper 20%).

Number of visit days and cost

Times of visit (outpatient) or days of hospitalization (inpatient), identified from diagnoses classified according to the disease classification code on each patient's medical care fee bill, were used. The total medical expense was the total medical care cost, and the copayment was a beneficiary burdened cost.

Types of healthcare institutions

In the Republic of Korea, total medical expense and beneficiary burdened cost are determined by the types of medical institutions according to size and are categorized as follows: A tertiary general hospital is a training hospital that covers severe cases. A general hospital is a large medical institution with over 100 admissions. Hospitals are defined as hospitals, dental hospitals, KM hospitals, and medical care hospitals that have 30 or more beds. A KM clinic is mainly for outpatients, and a health center is used for community health.

Classification of disease category

The Korean Classification of Diseases (KCD)-6, based on the International Classification of Diseases 10th Clinical Modification, was used to determine disease category. The main diagnosis was used for the classification. The top 10 primary diseases were selected to demonstrate KM claim patterns.

Statistical analysis

The units of observation were each individual or case included in the study sample. Descriptive statistics were used to describe the basic characteristics of the study sample. SAS software, version 9.2(SAS Institute Inc., Cary, NC), was used for data management and analyses.

Results

A total of 778,506 (370,435 males and 408,071 females) KM users between 2002 and 2013 were analyzed.

Characteristics of KM users by year (inpatients and outpatients)

Supplementary Tables S1 and S2 shows annual changes in sex, age, income level, number of visit days, total medical expenses, and beneficiary burdened costs according to inpatients and outpatients. Patients were defined as the number of diseased individuals among beneficiaries, and this value was counted according to disease, month, and medical care institution for the current year.

The number of KM users has increased steadily each year. Women use KM more often than men do. Across all age groups, patients in their 40s used KM most frequently until 2010. After 2011, individuals in their 50s used KM most often because patients in their late 40s aged into their 50s during the study period. Patients in the middle-high income group were the most frequent users of KM.

The mean number of outpatient visit days per person increased from 6 days in 2004–2006 to 7 days in 2005 and 8 days in 2011. The median number of outpatient visit days remained consistent at 3 days. The mean number of inpatient days of hospitalization per capita increased by 32 days in 2008 but decreased to 22 days after 2009. Regarding ambulatory patients, the total medical expense per person was $70 (U.S. dollars) in 2002 and rose consistently to $145 by 2013. By contrast, the mean total amount per capita of inpatients varied before 2008 (mean $574 in 2002 to $1301 in 2008).

Characteristics of KM users by the type of medical care institution

Figure 1 presents the characteristics of KM users by the type of medical care institution. Ambulatory patients used KM clinics most frequently across all years (96% or greater), and at least 76% of inpatients visited a KM hospital. Since 2010, the number of KM visits has been reported as the cross-employment of Western medicine and KM doctors where available.

FIG. 1.

Characteristics of Korean medicine (KM) users by the type of medical care institution.

Total medical expenses and mean numbers of visits of KM users by income level (outpatient)

Table 1 presents the total medical expenses and average numbers of visits of KM users by income level among outpatients. Since 2002, patients with a higher income level and more insurance have used KM often. Middle-high–income and high-income patients used KM more often than patients in the low-income and medical aid groups. Generally, patients with higher incomes had consistently higher total medical expenses per person. Regarding mean total medical expenses, high-income patients made up the group with the highest expenses at $75 in 2002 and $129 by 2010. Since 2011, the group with the highest mean total medical expenses has been the medical aid group, followed by the high-income group. In addition, the group with the highest mean number of visits from 2004 (6.8) to 2010 (8.3) was the high-income group; however, since 2010, individuals in the medical aid group had visited medical care institutions more frequently, followed by the high-income group.

Table 1.

Total Medical Expenses and Mean Visits of Korean Medicine Users by Income Level (Outpatient)

Total medical expense							Visits of KM users
Year	Medical aid	Low (>80%)	Low-middle (60%–80%)	Middle (40%–60%)	Middle-high (20%–40%)	High (≥20%)	Low (>80%)	Low-middle (60%–80%)	Middle (40%–60%)	Middle-high (20%–40%)	High (≥20%)	Low (>80%)
2002
Patients, n (%)	522 (0.3)	24,470 (12.6)	28,959 (14.9)	37,667 (19.4)	47,468 (24.5)	54,758 (28.2)	522 (0.3)	24,470 (12.6)	28,959 (14.9)	37,667 (19.4)	47,468 (24.5)	54,758 (28.2)
Mean expenses	86	73	67	65	67	75	7.0	5.9	5.4	5.2	5.5	6.1
Median expenses	38	38	35	33	34	38	3	3	3	3	3	3
Min expenses	7	5	5	4	5	5	1	1	1	1	1	1
Max expenses	1175	2087	2435	3083	2261	2760	104	180	230	264	235	265
2003
Patients, n (%)	696 (0.3)	26,177 (12.7)	30,188 (14.7)	38,506 (18.7)	50,028 (24.3)	60,286 (29.3)	696 (0.3)	26,177 (12.7)	30,188 (14.7)	38,506 (18.7)	50,028 (24.3)	60,286 (29.3)
Mean expenses	84	79	71	70	72	79	6.9	6.3	5.6	5.5	5.7	6.3
Median expenses	37	40	37	36	37	40	3	3	3	3	3	3
Min expenses	7	3	5	5	5	3	1	1	1	1	1	1
Max expenses	1069	2830	2768	2401	2425	2765	83	213	246	224	225	273
2004
Patients, n (%)	818 (0.4)	27,650 (12.6)	32,038 (14.6)	41,086 (18.8)	52,543 (24.0)	64,785 (29.6)	818 (0.4)	27,650 (12.6)	32,038 (14.6)	41,086 (18.8)	52,543 (24.0)	64,785 (29.6)
Mean expenses	81	84	76	73	78	86	6.5	6.5	5.8	5.7	6.1	6.8
Median expenses	39	42	39	38	40	42	3	3	3	3	3	3
Min expenses	7	3	5	5	4	3	1	1	1	1	1	1
Max expenses	1338	3019	3242	3168	3567	3439	107	287	270	239	283	265
2005
Patients, n (%)	1,163 (0.5)	30,067 (13.0)	34,640 (15.0)	42,731 (18.5)	54,354 (23.5)	67,869 (29.4)	1,163 (0.5)	30,067 (13.0)	34,640 (15.0)	42,731 (18.5)	54,354 (23.5)	67,869 (29.4)
Mean expenses	78	87	81	80	83	93	6.1	6.5	6.1	6.1	6.2	7.2
Median expenses	39	43	42	40	41	44	3	3	3	3	3	3
Min expenses	8	5	5	2	5	5	1	1	1	1	1	1
Max expenses	1404	2863	3425	3344	3032	2782	118	236	279	253	261	253
2006
Patients, n (%)	896 (0.4)	30,109 (12.6)	35,967 (15.1)	44,165 (18.5)	56,080 (23.5)	71,277 (29.9)	896 (0.4)	30,109 (12.6)	35,967 (15.1)	44,165 (18.5)	56,080 (23.5)	71,277 (29.9)
Mean expenses	84	95	87	86	88	101	6.2	6.9	6.3	6.2	6.4	7.4
Median expenses	40	45	43	42	43	46	3	3	3	3	3	3
Min expenses	5	3	5	1	2	4	1	1	1	1	1	1
Max expenses	1029	3578	3269	3246	3151	3564	86	281	243	258	231	276
2007
Patients, n (%)	857 (0.3)	32,493 (13.2)	37,008 (15.0)	45,976 (18.6)	57,365 (23.2)	73,184 (29.6)	857 (0.3)	32,493 (13.2)	37,008 (15.0)	45,976 (18.6)	57,365 (23.2)	73,184 (29.6)
Mean expenses	96	96	89	88	93	105	7.1	6.9	6.4	6.3	6.7	7.6
Median expenses	42	46	44	43	45	48	3	3	3	3	3	3
Min expenses	9	4	3	5	4	4	1	1	1	1	1	1
Max expenses	1232	3991	3266	3263	2975	3427	111	293	223	248	245	260
2008
Patients, n (%)	2,697 (1.1)	32,949 (13.5)	36,444 (14.9)	45,006 (18.4)	55,670 (22.7)	71,983 (29.4)	2,697 (1.1)	32,949 (13.5)	36,444 (14.9)	45,006 (18.4)	55,670 (22.7)	71,983 (29.4)
Mean expenses	69	103	95	94	96	112	4.8	7.2	6.5	6.5	6.6	7.9
Median expenses	37	49	46	46	46	51	2	3	3	3	3	3
Min expenses	6	5	4	2	4	3	1	1	1	1	1	1
Max	1991	3458	4506	3460	3367	3816	137	272	317	265	267	308
2009
Patients, n (%)	628 (0.3)	33,550 (13.4)	37,185 (14.9)	46,093 (18.4)	57,445 (23.0)	75,248 (30.1)	628 (0.3)	33,550 (13.4)	37,185 (14.9)	46,093 (18.4)	57,445 (23.0)	75,248 (30.1)
Mean expenses	108	114	102	101	108	123	7.5	7.5	6.7	6.7	7.1	8.3
Median expenses	49	53	50	49	50	55	3	3	3	3	3	3
Min expenses	9	3	4	3	3	4	1	1	1	1	1	1
Max expenses	1687	3911	3922	2845	3220	3852	116	294	261	254	237	310
2010
Patients, n (%)	556 (0.2)	34,971 (14.0)	37,554 (15.0)	44,961 (18.0)	57,238 (22.9)	74,939 (29.9)	556 (0.2)	34,971 (14.0)	37,554 (15.0)	44,961 (18.0)	57,238 (22.9)	74,939 (29.9)
Mean expenses	121	123	110	109	112	129	8.0	7.8	6.8	6.8	7.1	8.3
Median expenses	43	58	51	51	52	58	3	3	3	3	3	3
Min expenses	8	4	3	4	2	2	1	1	1	1	1	1
Max expenses	2531	3973	4191	3284	5590	4121	187	289	268	242	406	397
2011
Patients, n (%)	8,844 (3.4)	35,567 (13.7)	37,548 (14.5)	44,987 (17.4)	56,830 (21.9)	75,310 (29.1)	8,844 (3.4)	35,567 (13.7)	37,548 (14.5)	44,987 (17.4)	56,830 (21.9)	75,310 (29.1)
Mean expenses	219	133	119	117	120	138	11.8	7.9	7.0	6.9	7.1	8.4
Median expenses	93	61	55	55	55	63	5	3	3	3	3	3
Min expenses	3	1	2	2	2	2	1	1	1	1	1	1
Max expenses	5527	4173	4266	6700	4584	9408	283	233	262	546	322	892
2012
Patients, n (%)	8,041 (3.1)	31,785 (12.3)	34,709 (13.4)	43,291 (16.7)	56,501 (21.8)	85,001 (32.8)	8,041 (3.1)	31,785 (12.3)	34,709 (13.4)	43,291 (16.7)	56,501 (21.8)	85,001 (32.8)
Mean expenses	245	140	126	121	124	143	12.4	8.0	7.1	6.8	7.1	8.4
Median expenses	102	64	58	57	58	65	5	3	3	3	3	3
Min expenses	3	1	4	3	3	1	1	1	1	1	1	1
Max expenses	5415	4414	3837	9070	3771	11,579	296	297	260	820	277	968
2013
Patients, n (%)	7,975 (3.0)	37,371 (14.1)	38,433 (14.5)	46,354 (17.4)	58,318 (21.9)	77,351 (29.1)	7,975 (3.0)	37,371 (14.1)	38,433 (14.5)	46,354 (17.4)	58,318 (21.9)	77,351 (29.1)
Mean expenses	268	149	133	128	135	155	12.8	8.2	7.2	7.0	7.5	8.9
Median expenses	107	68	62	60	62	70	5	3	3	3	3	4
Min expenses	4	2	4	2	3	3	1	1	1	1	1	1
Max expenses	5670	9503	4467	4745	4645	10,059	276	784	256	248	241	805

Medical expenses are expressed as U.S. dollars.

KM, Korean medicine; min, minimum; max, maximum.

Top 10 major diseases for KM insurance claims among inpatients and outpatients

The KCD-Oriental Medicine (KCDOM)-2 was used for the data from 2002 to 2009, and KCDOM-3 was applied to the data after 2010. KCDOM-3 was developed for double coding with Western disease names (International Classification of Diseases).^5,16 The most frequently claimed diseases for outpatients were musculoskeletal diseases, such as backache and sprains, according to KCDOM-2. Stroke and nerve disorders, such as sequelae of stroke, paresthesia, and facial nerve palsy, ranked high, in addition to backache. Since 2010, musculoskeletal diseases, such as dorsalgia and soft tissue disorders, have been claimed most frequently. Supplementary Table S3 shows the top 10 diseases for KM insurance claims for inpatients. The most frequently claimed disease among inpatients each year from 2010 to 2012 was dorsalgia, followed by lumbar spine and pelvic lesions, other intervertebral disc disorders and cerebral infarction. In ambulatory patients, according to Supplementary Table S4, dorsalgia was also claimed most frequently, and soft tissue disorders, shoulder lesions, lumbar spine, and pelvic disorders (sprain and strain, dislocation) and gonarthrosis were also ranked high.

The median number of visit days among outpatients remained consistent at 3 days. The mean number of hospitalization days per capita in inpatients increased by 32 days in 2008 and has decreased to 22 days since 2009.

Discussion

This study identified the utilization patterns of KM by using a national representative sample cohort data and analyzed KM users by sex, age group, income level, and numbers of visit days and hospitalizations. These results indicate that the numbers of KM users and claims increased each year in both inpatients and outpatients. Women used KM more often than men. Patients in their 40s and 50s represented the largest proportion of KM users (approximately 20%). Middle-high–income and high-income patients used KM more than low-income and medical aid patients. The mean numbers of visits were 4.8 in the medical aid group and 7.9 in the high-income group, which implied that the mean of the high-income group was approximately twice that of the medical aid group in 2008.

These results support the report of the Third Korean Medical Use and Consumption Survey in 2015, in which higher-income groups demonstrated more frequent KM use.⁷ By contrast, the current study results conflict with Yoon and colleagues' study, which found that the relatively low-income group used KM more frequently compared with other groups.¹⁷ This difference was attributed to data collection methods and the personal income of interviewees included in the survey. In Taiwan, meanwhile, women were the main users of Chinese medicine. Individuals in their 20s and 30s and the low-income group took advantage of Chinese medicine.¹⁸ The income data of the NHIS-NSC were categorized by family income. The current results indicate that the group with the highest total medical expenditure was the medical aid group followed by the high-income group, from 2011 to 2013. This finding is not consistent with previous years. Thus our results do not warrant that the high income group spends more on medical expenses. Therefore, further investigation of the characteristics of KM users by income level is required.

Currently, total medical expenses and beneficiary burdened costs are determined by the types of medical institutions according to size in the Republic of Korea; this study analyzed the characteristics of KM users according to medical care institutions. Patients making KM clinic visits made up at least 96% of outpatient KM users, and patients with KM hospitalizations made up 76.1%–98.6% of hospitalized patients (Fig. 1). The proportion of medical care hospital users decreased consistently between 2008 and 2013 among inpatients; by contrast, the proportion of KM hospital and KM clinic users increased. Among outpatients, the proportion of KM hospital users increased slightly from 2008 to 2013, but this change does not appear to have been significant. The most frequently used institutions were KM clinics, as at least 96% of users visited KM clinics in 2012. According to the NHIS Statistics 2013, the number of KM hospitals gradually increased (146 in 2008 to 212 in 2013, a 45.2% increase). However, the number of KM clinics increased from 11,334 in 2008 to 13,100 in 2013 (15.6% increase), which was a lower rate of increase than that of the KM hospitals.¹⁹ Therefore, the current results appear to have been affected by this trend regarding the number of medical institution. Although KM departments have been established in Western medicine hospitals, these departments have not been used as frequently in Western medicine hospitals as in KM medical institutions.

These patterns of KM users by categorized medical care institutions were somewhat similar to patterns in Taiwan. According to Chen and colleagues' report, most TCM visits were to private TCM clinics (82.6%), followed by private TCM hospitals (12.0%), in outpatients. Western medicine hospitals with TCM departments accounted for only 4.6% of visits.²⁰ Another study showed that most of the active TCM physicians (82%) worked in personal practice clinics and that only a small portion (18%) worked in TCM hospitals, which supported Chen and colleagues' report.²¹

Additionally, the patterns of users of dentistry and Western medicine according to medical care institutions in the Republic of Korea were studied using the NHI Statistics 2013.¹⁷ Of the outpatients, 77% visited clinics for Western medicine, which was a much lower figure than the number KM users who visited outpatient clinics. The patterns of users receiving dental services were similar to those of KM users, as 95% visited dental clinics. Most Western medicine visits were to hospitals (38%), similar to the scale of KM hospitals followed by general hospitals (31%) in inpatients; hospitalizations for dental treatment made up over 99% of dental hospital visits.

Regarding the utilization of KM according to disease, musculoskeletal system disorders represented the most frequently claimed disease in both inpatients and outpatients, which corresponds to the results of the study by Lim and Yoon, which evaluated the NHI data in 2012 and the Report on the Usage and Consumption of Korean Medicine 2011.^17

–22 Compared with the Taiwan study, diseases of the respiratory system, diseases of the musculoskeletal system, and connective tissue injury and poisoning accounted for 22.1%, 18.1%, and 16.1% of claims, respectively.^18,23

The major strength of the current study was that it investigated changes in usage patterns according to income level. The study used long-term cohort data that can be used to predict KM use patterns and user characteristics according to sociodemographic factors. Additionally, this study included a relatively large sample size of KM users.

The limitations of the study were as follows. Because most KM treatments, including herbal decoction prescriptions, are not covered by the KNHIP, determining total KM utilization patterns is difficult. Although the proportion of KM hospitals in total KM utilization was slightly low, when considering the rate of health insurance coverage at a KM hospital (30.8%), the noncovered services at KM hospitals (56.0%) had a slightly higher proportion compared with the noncovered services of Western medicine according to the National Research on Medical Payment in the Republic of Korea 2013.²² Oh et al. investigated the relative preference for traditional KM services according to disease using data from the 2008 Korea Health Panel. This study reported the numbers of outpatient visits due to patients' diseases and the costs paid directly by patients, including copayments and the cost of care, that are not covered by national health insurance, including the cost of herbal medicines at KM hospitals and clinics.²⁴ Although this study focused on information about claims did not include noncovered services, which could not be measured accurately compared with Oh and colleagues' previous study, the current study results supported Oh and colleagues' study in terms of preferences for KM for specific diseases. KM use was higher in patients with musculoskeletal system diseases or cerebrovascular disease, which was similar to the results of the study of the Korea Health panel. Therefore, it seems that the limitations of the study were not highly influential.

Another limitation is that the diagnosis code designed for insurance claims may be inaccurate. To estimate the health equity of KM in the insurance system, continuous monitoring and assessments are necessary.

On the basis of this study, further research should be conducted to identify the factors affecting KM use and health status. Specifically, detailed comparison studies with other countries that have a single-payer insurance system, such as Taiwan, are required.^{18

–26}

Conclusion

This investigation was the first study of KM utilization patterns with a large sample of national representative data from the NHIS-NSC 2002–2013. Although controversy exists regarding utilization patterns according to income level, this study has confirmed the results of previous studies of KM utilization for sex and disease tendency. It seems that these patterns of utilization exist because of the high proportion of KM services that are not included in the NHIS system, which indicates that the KM services covered by NHI are restricted and have low economic accessibility. The results of this study contribute to understanding of KM users and can be used as a basic foundation for related policy decisions made by government officials and medical professionals. Further studies should be conducted to explore the predictors of KM utilization, and comparison studies of Western medicine in the Republic of Korea and other countries should be performed.

Footnotes

Acknowledgments

This work was supported by a grant from Kyung Hee University in 2012 (KHU-20121688).

Author Disclosure Statement

No competing financial interests exist.

References

World Health Organization. WHO Traditional Medicine Strategy: 2014–2023. Geneva, Switzerland: World Health Organization, 2013.

World Health Organization. Guidelines on Developing Consumer Information on Proper Use of Traditional, Complementary and Alternative Medicine. Geneva, Switzerland: World Health Organization, 2004.

World Health Organization. WHO Traditional Medicine Strategy 2002–2005. Geneva, Switzerland: World Health Organization, 2002.

National Institutes of Health. NIH News Release. NIH Panel Issues Consensus Statement on Acupuncture. 1997. Online document at: http://www.nih.gov/news/pr/nov97/od-05.html Accessed September 1, 2015 .

Yin

, Ko

. Introduction to the history and current status of evidence-based Korean medicine: a unique integrated system of allopathic and holistic medicine. Evid Based Complement Alternat Med, 2014; 740515.

Cha

, Oh

, Park

, et al. Historical difference between traditional Korean medicine and traditional Chinese medicine. Neurol Res, 2007; 29 Suppl 1:S5-9.

Korea Ministry of Health and Welfare, Korea Institute of Oriental Medicine (KIOM). The 3rd Korean Medical Use and Consumption Survey. Korea Health Industry Development Institute (KHIDI) Publication No. 11-1352000-000547-12. Sejong City, Korea: Korea Ministry of Health and Welfare, 2014.

Ock

, Choi

, Cha

, et al. The use of complementary and alternative medicine in a general population in South Korea: results from a national survey in 2006. J Korean Med Sci, 2009; 24:1–6.

Park

. Integrated medicine in the East may differ from that in the West. Br Med J, 2001; 322:1126.

10.

Kwon

. Thirty years of national health insurance in South Korea: lessons for achieving universal healthcare coverage. Health Policy Plan, 2009; 24:63–71.

11.

National Health Insurance Service (NHIS). Social Security System in Korea. Online document at: http://www.nhis.or.kr/static/html/wbd/g/a/wbdga0301.html Accessed June 9, 2016 .

12.

The joint committee of the Association of Korean Oriental Medicine (AKOM), Korea Institute of Oriental Medicine (KIOM), and Busan National University School of Korean Medicine. (Daejeon, Republic of Korea), 2013 Year Book of Traditional Korean Medicine. KIOM Publication No. ISSN 2233-4610. 2013: 233–235.

13.

Korea Ministry of Government Legislation (The National Law Information Center). Enforcement Decree of the National Health Insurance Act: Article 22. Costs of Benefit in Kind for Medicines and Materials for Medical Treatment; 2. Medicines other than the oriental medicines: purchase price. 2015. Online document at: http://elaw.klri.re.kr/kor_service/lawView.do?hseq=35629&lang=ENG Accessed June 9, 2016 .

14.

Korea Institute of Oriental Medicine. 2008 Korean Medicine Utilization Fact-Finding Study. Ministry of Health and Welfare Publication No. 11-1351000-000223-01. Deajeon, Korea: Korea Institute of Oriental Medicine, 2008.

15.

National Health Insurance Service. National Health Insurance Data Sharing Service sample cohort DB. Online document at:https://nhiss.nhis.or.kr/bd/ab/bdaba000eng.do Accessed June 9, 2016 .

16.

Gao

, Watanabe

. Introduction of the World Health Organization project of the international classification of traditional medicine. Chin J Integr Med, 2011; 9:1161–1164.

17.

Yoon

, Park

, Chu

, Choi

, Lee

. A study on the characteristics of infrequent and frequent outpatients visiting Korean traditional medical facilities. Osong Public Health Res Perspect, 2015; 6:170–183.

18.

Chang

, Huang

, Chou

, Lee

, Kao

, Huang

. Utilization patterns of Chinese medicine and Western medicine under the National Health Insurance Program in Taiwan, a population-based study from 1997 to 2003. BMC Health Serv Res, 2008; 8:170.

19.

National Health Insurance Service. National Health Insurance Statistical Yearbook. 2013. NHIS Publication No. ISSN 1738-8945. Seoul, Korea: National Health Insurance Service, 2014: 40–41, 122. Online document at: http://www.nhis.or.kr/menu/retriveMenuSet.xx?menuId=F3321 Accessed June 9, 2016 .

20.

Chen

, Chen

, Kung

, et al. Use frequency of traditional Chinese medicine in Taiwan. BMC Health Serv Res, 2007; 7:26.

21.

Chi

, Lee

, Lai

, Chen

, Chang

, Chen

. The practice of Chinese medicine in Taiwan. Soc Sci Med, 1996; 43:1329–1348.

22.

Lim

. Korean medicine coverage in the National Health Insurance in Korea: present situation and critical issues. Integr Med Res, 2013; 2:81–88.

23.

Chang

, Liu

, Chen

. Changes in the use of complementary and alternative medicine in Taiwan: a comparison study of 2007 and 2011. Complement Ther Med, 2014; 22:489–499.

24.

, Yoon

, Park

, An

. Disease-specific differences in the use of traditional Korean medicine in Korea. BMC Complement Altern Med, 2015; 15:141.

25.

National Health Insurance Service (NHIS). National Research on Medical Payment in Korea 2013. 2014: 36.

26.

Shih

, Lew-Ting

, Chang

, Kuo

. Insurance covered and non-covered complementary and alternative medicine utilisation among adults in Taiwan. Soc Sci Med, 2008; 67:1183–1189.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.03 MB

0.02 MB

0.03 MB