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An epidemic of cataract surgery in Korea: the effects of private health insurance on the National Health Insurance Service
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Hyejin Lee, Soo-Hee Hwang, Choon-Seon Park, Seol-Hee Chung, Catherine L. Chen, Jin Yong Lee, Jin Soo Lee
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Epidemiol Health. 2024;46:e2024015. Published online January 6, 2024
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DOI: https://doi.org/10.4178/epih.e2024015
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Abstract
OBJECTIVES
In Korea, the National Health Insurance Service (NHIS) covers essential healthcare expenses, including cataract surgery. To address concerns that private health insurance (PHI) might have inflated the need for such procedures, we investigated the extent of the PHI-attributable increase in cataract surgery and its impact on NHIS-reimbursed expenses.
METHODS This retrospective, observational study uses nationwide claims data for cataract surgery from 2016 to 2020. We examined trends in utilization and cost, and we estimated the excess numbers of (1) cataract operations attributable to PHI and (2) types of intraocular lenses used for cataract surgery in 2020.
RESULTS Between 2016 and 2020, a 36.8% increase occurred in the number of cataract operations, with increases of 63.5% and 731.8% in the total healthcare costs reimbursed by NHIS and PHI, respectively. Over a 5-year period, the surgical rate per 100,000 people doubled for patients aged <65 years (from 328 in 2016 to 664 in 2020). Among the 619,771 cases in 2020 of cataract surgery reimbursed by the Korean diagnosis-related group system, more non-NHIS-covered intraocular lenses were used for patients aged <65 years than ≥65 years (68.1 vs. 14.2%). In 2020 alone, an estimated 129,311 excess operations occurred, accounting for an excess cost of US$115 million.
CONCLUSIONS A dramatic increase in the number and cost of cataract operations has occurred over the last 5 years. The PHI-related increase in operations resulted in increased costs to NHIS. Measures to curtail the non-indicated use of cataract surgery should be implemented regarding PHI.
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Summary
Korean summary
백내장 수술에서 실손보험으로 인한 의료비 증가 수준을 확인하고 건강보험급여 비용에 미치는 영향을 조사했을 때 2016년과 2020년 사이에 백내장 수술 건수는 36.8% 증가했으며, 건강보험과 실손보험에서 지급한 총 의료 비용은 각각 63.5%와 731.8% 증가했다. 백내장 수술은 65세 미만에서 주로 증가하였으며, 이 연령층은 공단에서 급여하지 않는 고가의 인공수정체를 더 많이 사용하였다. 추정 초과 수술 건수는 2020년에만 129,311건으로 1억 1,500만 달러의 초과 비용이 발생했다.
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A study on the validity of vasectomy status for both the husband vasectomized and his spouse
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Joung Soon Kim, Yong Heo, Jin Soo Lee, I-cheng Chi
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Korean J Epidemiol. 1984;6(1):54-61.
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Abstract
The objective of this study is to validate the vasectomy status reported by both the husband vasectomized and his spouse prior to the main epidemiological study of cardiovascular diseases in Korean men with special concern for vasectomy as a risk factor of the disease.
The study was carried out in Choonchun city and Chunseong county which have been served by the Community Health Program of Seoul National University for more than ten years. The records of vasectomy for the men living in these areas have been kept accurate by the local family planning association since 1972 providing an unique opportunity for this type of study.
With assistance of the community health program staff, the list of vasectomized subjects including the address was obtained from the family planning association. The total number of eligibles were 512 in Choonchun city and 142 in Chunseong county. The principle of sample selection was based on the longer duration since the vasectomy among eligibles who were available for the interview. Fifty couples from Choonchun city and fifty couples from Chunseong county were selected for the study and matched by their neighborhood control couples for whom the husbands were not vasectomized. Starting from the December of 1983, ten MPH students, five male-female pairs visited these 200 couples home and interviewed. The husbands and wives were interviewed at the same time but separately by the same sex interviewer to avoid communication barrier between the interviewees and interviewers, and the bias that could occur due to opinion exchange between the husband and wife prior to the interview.
The results obtained are as followings:
1. The mean age at the time of vasectomy was 34.4±5.0 years while the age at the time of interview was 42.9±5.9 years with about 8 years of duration from the vasectomy to the interview. The duration of marriage till the vasectomy was 8.8 years average
2. In reporting of vasectomy status, the sensitivity and the sensitivity were 0.99 and 1.0 respectively in both husbands and wives. Kappa, an index value of agreement between husband and wife on vasectomy status, was also 0.99. The agreement rate between the year recorded and the year stated on the year of vasectomy was 36.4% in husband and 31.0% in wife. The agreement rate, however, within two year difference between recorded and stated year of vasectomy was 79.2% in husband and 84.4% in wife. These agreement rates were lower than that of the year of marriage (p < 0.01)
3. In multiple regression analysis using the duration since the vasectomy recorded (A) as dependent variable and the duration stated (B), age (C), level of education (D) as independent variables, the coefficient of determination (R2) was the higher when they were transformed to natural logarithm. The regression models duration of vasectomy from the data provided by interview are as follows:
LNA(husband) = -0.199+0.760LNB+0.144LNC+0.101LND :R2=0.57
LNA(wife) = 1.311+0.725LNB-0.203LNC :R2=0.54
The scatergram between the records duration and the estimated duration by the model fitted better than the duration stated, when 20 samples randomly selected from the data were tried.
(This study was supported by the Family Health International, Research Triangle Park, N.C.)
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