National Health Insurance System Research Articles

Association Between Menopausal Hormone Therapy and Risk for Parkinson's Disease.

The relationship between menopausal hormone therapy (MHT) and risk of Parkinson's disease (PD) remains controversial. This nationwide population-based cohort study investigated the association between MHT and PD development. Data from the National Health Insurance System of South Korea from 2007 to 2020 were used. The MHT group included women who underwent MHT for the first time between 2011-2014, while the non-MHT group included women who visited a healthcare provider for menopause during the same period but never received hormonal therapy. We used propensity score matching (1 : 1) to adjust for potential confounders, and Cox regression models to assess the association between MHT and PD. We selected 303,260 female participants (n = 151,630 per MHT and non-MHT groups). The median age of the participants was 50 (48-54) years, and the follow-up period lasted 7.9 (6.9-8.9) years. Cox regression analysis revealed an increased risk of PD with MHT (hazard ratio [HR] 1.377, 95% confidence interval [CI] 1.184-1.602), particularly with tibolone (HR 1.554, 95% CI 1.297-1.861) and estrogen alone (HR 1.465, 95% CI 1.054-2.036). Tibolone and estrogen alone were linked to PD within three years; however, no association was observed after three years. In contrast, the use of combined estrogen-progesterone was linked to a higher risk of PD, which increased with the duration of MHT (HR 1.885, 95% CI 1.218-2.918 for over five years). This study demonstrated that the MHT is closely associated with the risk of PD in a regimen- and duration-specific manner.

Secondary Malignancies in Multiple Myeloma in Korean Patients: A Nationwide Population-Based Study.

This study investigated the incidence of secondary malignancy in multiple myeloma (MM) patients compared with that in the general population using a population-based database covering all residents in Korea. Based on the national health insurance system in Korea, all people primarily diagnosed with MM between January 1, 2010 to December 31, 2018 were identified. A total of 9,985 MM patients aged ≥ 20 years in Korea were included. Among them, 237 (2.4%) developed secondary malignancies by 2018. The standardized incidence rates (SIRs) of all secondary malignancies in MM patients were 0.87 (95% confidence interval [CI], 0.76 to 0.98), with a higher incidence of hematologic malignancies than in the general population with an SIR of 3.80 (95% CI, 2.61 to 5.00). The incidence rates of both lymphoid malignancy (SIR, 3.56; 95% CI, 2.31 to 4.82) and myeloid malignancy (SIR, 3.78; 95% CI, 1.16 to 6.39) were higher in MM patients than in the general population. In contrast, a lower incidence of solid cancer was observed in MM patients than in the general population (SIR, 0.76, 95% CI, 0.65 to 0.86). There was no significant difference in survival in MM patients without secondary malignancies, with hematologic malignancy, and with solid cancer (p=0.413). MM patients had a greater risk of secondary malignancies, especially hematologic malignancies, than the general population. Future studies with a focus on analyzing patients' history, treatment details, and genetic information in various stages of MM patients are needed to better understand the mechanism behind this increased risk.

The association between migraine and Parkinson's disease: a nationwide cohort study.

Clinical studies have suggested an association between migraine and the occurrence of Parkinson's disease (PD). However, it is unknown whether migraine affects PD risk. We aimed to investigate the incidence of PD in patients with migraine and to determine the risk factors affecting the association between migraine and PD incidence. Using the Korean National Health Insurance System database (2002-2019), we enrolled all Koreans aged ≥40 years who participated in the national health screening program in 2009. International Classification of Diseases (10th revision) diagnostic codes and Rare Incurable Diseases System diagnostic codes were used to define patients with migraine (within 12 months of enrollment) and newly diagnosed PD. We included 214,193 patients with migraine and 5,879,711 individuals without migraine. During 9.1 years of follow-up (55,435,626 person-years), 1,973 (0.92%) and 30,664 (0.52%) individuals with and without migraine, respectively, were newly diagnosed with PD. Following covariate adjustment, patients with migraine showed a 1.35-fold higher PD risk than individuals without migraine. The incidence of PD was not significantly different between patients with migraine with aura and those without aura. In males with migraine, underlying dyslipidemia increased the risk of PD (p=0.012). In contrast, among females with migraine, younger age (<65 years) increased the risk of PD (p=0.038). Patients with migraine were more likely to develop PD than individuals without migraine. Preventive management of underlying comorbidities and chronic migraine may affect the incidence of PD in these patients. Future prospective randomized clinical trials are warranted to clarify this association.

Bridging the Language Gap: The Role of Human-Mediated Translation in Japanese Medical Settings.

Introduction Foreign residents in Japan often face challenges accessing healthcare due to language barriers, potentially leading to health inequities. This study aimed to assess the utilization and impact of human-mediated translation services in a specific medical setting in Tokyo. Methods A retrospective investigation was conducted on medical records of foreign patients who utilized human-mediated translation services at Navitas Clinic Tachikawa (Tachikawa, Tokyo, Japan) from November 2017 to December 2021. Data on age, gender, language used, department visited, diagnosis, insurance status, and booking methods were analyzed. Results Out of the 124 foreign patients who utilized the human-mediated translation services during the study period, 69 (56%) were male, and 55 (44%) were female. The median age was 35 years, with a range from 3 to 61 years. English was the predominant language used by 34 patients (59%), followed by Chinese for nine patients (16%) and Spanish for four patients (7%). The majority, 107 patients (86%) visited the internal medicine department, nine patients (7%) consulted dermatology, and six patients (5%) visited pediatrics. Regarding insurance status, 47 patients (81%) were insured, three patients (5%) were uninsured by the Japanese national health insurance system, and eight patients (14%) were self-pay. The primary mode of appointment booking was at the reception desk, with 112 patients (90%) using this method, while 12 patients (10%) made reservations online. Conclusions The findings of this study underscore the importance of human-mediated translation services for improving healthcare accessibility for foreign residents in Japan, emphasizing the need to address language barriers and promote health equity in clinical settings. Future studies should also explore challenges faced in patient-physician interactions from a linguistic perspective and potential technological solutions to enhance these services.

Tooth Loss as a Predictor of Long-Term Care Requirements in the Elderly: A Study in Kobe City, Japan.

The Kobe project, which utilizes prospective data from the national health insurance system, focuses on early detection and preventive strategies through the Frail Kenshin health check-up program. Previous research has underscored the correlation between tooth loss and the decline in physical and cognitive functions. In this study, using Kobe project data, we examined the link between remaining teeth and long-term care needs in individuals aged 64-65 years, with primary and secondary objectives involving various health parameters and quality of life. We analyzed baseline data from a prospective study conducted alongside the Frail Check program for generally healthy individuals aged 64-65 yearsto examine the relationship between the number of remaining teeth and various health indicators. This study focused on citizens aged 64-65 years to identify those at risk of needing long-term care by the age of 65 years. Data from 1,530 participants were obtained, excluding eight individuals for specific reasons. At the end of the follow-up period, 41 (2.7%) individuals required supportand 15 (1.0%) needed long-term care alone. The data revealed a significant association between the number of remaining teeth and the need for long-term care or support, as demonstrated by the Cochran-Armitage trend test (p<0.001). Although trends were noted for nutrition and total Cognitive Functional Instrument Self scores, they did not reach statistical significance. Additionally, a decrease in the number of remaining teeth was significantly associated with worse European Quality of Life Five Dimensions (EQ-5D-5L) visual analog scale scores, mobility, and regular activities (p<0.001). Tooth loss indicates the potential long-term care needs of older adults. Monitoring oral health is crucial for addressing care requirements.

The use of telemedicine in primary health care during COVID-19: perceptions from health care professionals

This research aims to explore the perceptions of health care professionals about the use of telemedicine which took place in Banguntapan 2 primary health care. This study was part of a bigger action research study and was done to obtain an understanding of the telemedicine service as the first step of the diagnosing phase. The respondents are the chief of primary health care, the coordinator of individual health initiatives as well and the coordinator for the appointment program. The selected healthcare professionals were chosen to obtain the telemedicine best-practice in healthcare facilities and to serve as the data triangulation to avoid bias in the answers collected. The result of the interviews revealed four topics: i) the use of telemedicine in minimizing direct contact with the patient; ii) the need to expand the existing system; iii) the utilization of WhatsApp, a popular online platform in the community; and iv) the possibility to merge with the existing online system of national health insurance (JKN) and digital government service (DGS). Some recommendations to improve are to implement a one-stop messaging service, optimization of WhatsApp, and bridge the appointment system to the existing regional DGS.

Effects of urinary tract infection during the first years of life in subsequent growth: a nationwide comparative matched cohort study.

Although various childhood illnesses are known to influence growth status, the impact of urinary tract infections (UTI) on subsequent childhood growth remains unclear. This study was conducted to examine the association between UTI during infancy and growth status at 30-36 months. Nationwide population-based matched cohort study was done using data from the Korean National Health Insurance System (NHIS) and the Korean National Health Screening Program for Infants and Children (NHSPIC) between January 2018 and December 2020. Height and weight standard deviation scores (SDSs) at the fourth Korean NHSPIC conducted at 30-36 months were compared between children who experienced UTI during infancy and age- and sex-matched controls. We used weighted multiple linear regression analysis with inverse probability of treatment weighting (IPTW) and identified differences between the two groups using β coefficient with corresponding 95% confidence intervals (CIs). We analyzed 84,519 children diagnosed with UTI during infancy and 84,519 age- and sex-matched controls. The height SDS between children who experienced UTI and the control group was not statistically different (β coefficient for height SDS, -0.0034; 95% CI: -0.0121 to 0.0054). However, the body mass index (BMI) SDS was significantly higher in children who had experienced UTI (β coefficient for BMI SDS, 00426; 95% CI: 0.0304 to 0.0547). Subgroup and sensitivity analysis showed consistent results. Our findings suggest that a history of UTI during infancy is associated with high BMI measured at 30-36 months.

Changes in Fatty Liver Disease and Incident Diabetes Mellitus in Young Korean Adults

Introduction: This study sought to assess the association between the changes in nonalcoholic fatty liver disease (NAFLD) and risk of type 2 diabetes in young individuals with prediabetes. Methods: Data from the Korean National Health Insurance System database were collected from 2009 to 2019 and analyzed in 2022. A total of 446,813 young adults aged 20–39 years with prediabetes who underwent two National Health Screening examinations from 2009 to 2012 were followed-up. NAFLD was defined as a fatty liver index (FLI) ≥60 without liver disease or history of alcohol abuse. Multivariable Cox proportional hazards regression was used to calculate the hazard ratio (HR) and confidence intervals (CIs) for type 2 diabetes according to NAFLD changes. Results: During a median follow-up of 8.3 years, 26,464 (5.9%) young individuals developed type 2 diabetes. Multivariable adjusted HR of type 2 diabetes according to the NAFLD change was 5.38 (95% CI 5.08–5.70) in individuals with persistent NAFLD when compared to those who never had NAFLD. Even in individuals who were consistently nonobese, resolved NAFLD, new NAFLD, and persistent NAFLD were associated with > three-fold increased risk of type 2 diabetes compared to nonobese individuals without NAFLD. The risk of type 2 diabetes also increased in obese individuals without NAFLD by two-fold when compared to nonobese individuals without NAFLD. Conclusions: NAFLD that either existed persistently or ever existed plays a critical role in the development of type 2 diabetes in young adults with or without obesity. Nonobese individuals with NAFLD warrant special attention.

Lumbar radiculopathy and fracture risk: A Korean nationwide population-based cohort study

IntroductionLumbar radiculopathy is a common disease with a high economic burden, and fractures in adults are a significant public health problem. However, studies of the relationship between lumbar radiculopathy and fractures are scarce. We investigated the fracture risk in patients with lumbar radiculopathy. MethodsThis nationwide retrospective cohort study identified 815,101 patients with lumbar radiculopathy and randomly matched individuals without lumbar radiculopathy (1:1) who were included in the Korean National Health Insurance System in 2012. Cox proportional hazards regression analyses were performed to calculate the hazard ratio (HR) for fracture risk in patients with lumbar radiculopathy. ResultsThe study included 301,347 patients with lumbar radiculopathy and matched 289,618 individuals without lumbar radiculopathy. Compared to individuals without lumbar radiculopathy, patients with lumbar radiculopathy had a 27 % increased fracture risk (adjusted HR = 1.27, 95 % confidence interval = 1.24–1.31). The Kaplan-Meier plot showed a significantly higher fracture incidence in patients with lumbar radiculopathy than in individuals without lumbar radiculopathy at all times. ConclusionLumbar radiculopathy is significantly associated with fracture risk.

Long-Term Cumulative Exposure to High γ-Glutamyl Transferase Levels and the Risk of Cardiovascular Disease: A Nationwide Population-Based Cohort Study.

Elevated γ-glutamyl transferase (γ-GTP) levels are associated with metabolic syndrome. We investigated the association of cumulative exposure to high γ-GTP with the risk of cardiovascular disease (CVD) in a large-scale population. Using nationally representative data from the Korean National Health Insurance system, 1,640,127 people with 4 years of consecutive γ-GTP measurements from 2009 to 2012 were included and followed up until the end of 2019. For each year of the study period, participants were grouped by the number of exposures to the highest γ-GTP quartile (0-4), and the sum of quartiles (0-12) was defined as cumulative γ-GTP exposure. The hazard ratio for CVD was evaluated using the Cox proportional hazards model. During the 6.4 years of follow-up, there were 15,980 cases (0.97%) of myocardial infarction (MI), 14,563 (0.89%) of stroke, 29,717 (1.81%) of CVD, and 25,916 (1.58%) of death. Persistent exposure to high γ-GTP levels was associated with higher risks of MI, stroke, CVD, and death than those without such exposure. The risks of MI, stroke, CVD, and mortality increased in a dose-dependent manner according to total cumulative γ-GTP (all P for trend <0.0001). Subjects younger than 65 years, with a body mass index <25 kg/m2, and without hypertension or fatty liver showed a stronger relationship between cumulative γ-GTP and the incidence of MI, CVD, and death. Cumulative γ-GTP elevation is associated with CVD. γ-GTP could be more widely used as an early marker of CVD risk, especially in individuals without traditional CVD risk factors.

Understanding Thrombosis and Hemorrhage in Myeloproliferative Neoplasms through a Nationwide Study

Introduction The incidence of Myeloproliferative Neoplasms (MPNs), including Essential Thrombocythemia (ET), Polycythemia Vera (PV), and Primary Myelofibrosis (PMF) are increased. Thrombosis and hemorrhage are major complications of ET and PV. Leukemic transformation is a rare but fatal complication of MPNs. However, their incidence and risk factors of thrombosis and hemorrhage in a nationwide population are not fully known. Methods This study used nationwide data from the Korean National Health Insurance System (NHIS). We assessed thrombosis, hemorrhage, and leukemic transformation events in a cohort of all 9,779 patients diagnosed with MPNs during 2011-2016. A Big data formed by the NHIS contains demographic, clinical characteristics (smoking, body mass index, dates of birth, last follow up date, gender), health care utilization, treatment medication and health screening for the whole Korean population (Table 1). Results Of total 9,779 patients with MPNs, 5,970 (61.04%) had ET, 2,655(27.2%) PV, 586 (5.9%) PMF, and 568 (5.8%) unspecified MPN (MPN-U). 2,187 (22.4%) patients were diagnosed arterial thromboembolism including cerebral infarction and other thromboembolism during follow-up. And 1,029 (10.5%) patients were diagnosed venous thrombus including pulmonary thromboembolism. 254 (2.6%) patients were diagnosed intracerebral hemorrhage. Secondary leukemia (acute myeloid leukemia (n=482, 4.9%), acute lymphocytic leukemia (n=38, 0.4%), chronic myeloid leukemia (n=423, 4.3%), and chronic lymphocytic leukemia (n=22, 0.2%)) arising from MPNs were noted. Secondary myelofibrosis was noted in 321 (3.3%) patients with MPNs. Multivariate analysis revealed several risk factors for thrombosis and hemorrhage in patients with PV and ET. In patients with PV, age over 60 years (hazard ratio [HR]=2.199, 95% confidence interval [CI]=1.863-2.596, p&amp;lt;0.001), hypertension (HR=1.519, 95% CI=1.269-1.818, p&amp;lt;0.001), and atrial fibrillation/flutter (HR=1.561, 95% CI=1.088-2.241, p=0.016) were identified as significant risk factors for thrombosis. Additionally, age over 60 years (HR=2.896, 95% CI=1.637-5.123, p&amp;lt;0.001) was associated with an increased risk of hemorrhage in patients with PV. In patients with ET, multivariate analysis identified age over 60 years (HR=2.495, 95% CI=2.217-2.809, p&amp;lt;0.001), male sex (HR=1.147, 95% CI=1.034-1.271, p=0.009), hypertension (HR=1.563, 95% CI=1.385-1.764, p&amp;lt;0.001), dyslipidemia (HR=1.216, 95% CI=1.084-1.364, p=0.001), atrial fibrillation/flutter (HR=1.537, 95% CI=1.091-2.165, p=0.014), and hematologic malignancy (HR=1.294, 95% CI=1.097-1.527, p=0.002) as significant risk factors for thrombosis. Moreover, age over 60 years (HR=2.657, 95% CI=1.744-4.048, p&amp;lt;0.001) and hypertension (HR=1.775, 95% CI=1.161-2.713, p=0.008) were found to be significant risk factors for hemorrhage in patients with ET. Conclusions This is the first Korean nationwide study to understand thrombosis and hemorrhage in patients with MPNs. This set of data can be utilized to compare the Asian patients with MPNs to international data and guidelines.

Increased risk of sleep disturbances in patients with rosacea: A nationwide population-based cohort study.

Rosacea is a chronic inflammatory skin disorder linked to various mental disorders, but little is known about the impact of rosacea on sleep disorders. The aim of this study is to confirm the association of rosacea with sleep disorders using a large administrative data set. This nationwide population-based retrospective cohort study enrolled 1129 individuals with rosacea and 11 017 age- and sex-matched controls without rosacea from the Korean National Health Insurance System database from 2002 to 2015. The prevalence of sleep disorder (7.8%) was significantly higher in patients with rosacea than in controls (5.81%; p < 0.001). Rosacea was associated with an increased risk of sleep disorder (adjusted odds ratio [aOR], 1.287 [95% confidence interval (CI), 1.022-1.623]). Among a variety of sleep disorders, patients with rosacea were likely to have an increased risk of insomnia (aOR, 1.318 [95% CI, 1.002-1.743]). In subgroup analysis, female patients with rosacea (aOR, 1.297 [95% CI, 1.010-1.722]) and those with rosacea and dyslipidemia (aOR, 1.417 [95% CI, 1.062-1.891]) were at a higher risk of having a sleep disorder. Rosacea is associated with an increased risk of having sleep disorders. The management of modifiable risk factors is important for managing sleep disorders in patients with rosacea.

Cost-effectiveness analysis comparing repetitive transcranial magnetic stimulation therapy with antidepressant treatment in patients with treatment-resistant depression in Japan

Repetitive transcranial magnetic stimulation (rTMS) for patients with treatment-resistant depression (TRD) became covered by the National Health Insurance (NHI) in Japan since 2019. Although the evidence of rTMS for TRD is well established, the cost-effectiveness of rTMS versus antidepressants has not been thoroughly analyzed in Japan. Thus, we aimed to evaluate the cost-effectiveness of rTMS for TRD under the NHI system using a microsimulation model to compare the direct costs and quality-adjusted life years (QALYs). Model inputs of clinical parameters and the utility were derived from published literature. Cost parameters were estimated from the Japanese Claim Database. The robustness of the analyses was evaluated with sensitivity analysis and scenario analysis. The analysis estimated that rTMS increased effectiveness by 0.101QALYs and total cost by ¥94,370 ($689) compared with antidepressant medications. As a result, the incremental cost-effectiveness ratio (ICER) of rTMS was estimated to be ¥935,984 ($6,832)/QALY. In the sensitivity and scenario analyses, ICER did not exceed ¥5 million ($36,496)/QALY as the reference value of the Japanese public cost-effectiveness evaluation system. rTMS therapy for TRD can be a cost-effective treatment strategy compared to antidepressant medication under the NHI system in Japan.

Prognostic impact of cancer genomic profile testing for advanced or metastatic solid tumors in clinical practice.

Cancer genomic profile (CGP) testing, which is covered by the national health insurance system in Japan, has been introduced as a routine clinical practice. However, the effects of CGP testing on prognoses remain unclear. Drug accessibility rates and prognoses after CGP testing were retrospectively investigated in 713 patients who underwent CGP testing examined by our molecular tumor board between November 2019 and October 2022,. Overall survival (OS) was examined using the log-rank test and the Kaplan-Meier method. The median age of patients (326 males and 387 females) was 58 years (12-85 years). CGP testing revealed one or more gene mutations in 681 cases (95.5%), among which actionable gene mutations were detected in 439 (61.6%). Although treatment options were recommended for 285 cases (40.0%) by the molecular tumor board, only 45 received treatment based on their gene mutations. During the median observation period of 8.6 months, 351 (49.2%) patients died of the exacerbation of existing diseases. No significant differences were observed in OS between patients treated with and without genomically matched therapy (p = 0.285). According to clinical responses to treatment based on gene mutations, median OS was significantly longer in patients who achieved partial response and stable disease (26.5 months; 95% CI 14.4-38.6) than in those with progressive disease and not evaluated (9.8 months; 95% CI 5.8-13.8, p = 0.013). Responses to treatment based on gene mutations may improve prognoses, and it is important to increase the drug accessibility rate after CGP testing.

AVAILABILITY OF MEDICINES AS A RESULT OF REIMBURSEMENT MECHANISMS AND MEDICAL INSURANCE IS AN ISSUE FOR DISCUSSION

Availability of medicines, their quantity, quality, and appropriate documentation organization regarding distribution, storage, and sales – is one of the priority tasks of the healthcare system of each country. In European Union countries, a significant portion of expenditures for ensuring pharmaceutical supplies is covered by the state, implementing the principle of equal access of the population to effective medicines at an affordable price, which underlies the mechanisms of pricing and reimbursement. To achieve these goals, requirements are outlined in Directive 89/105/EEC of December 21, 1989, «On the transparency of measures regulating the pricing of medicinal products for human use and their inclusion in the system of national health insurance», aimed at promoting the development of the pharmaceutical industry both in the direction of developing expensive innovative drugs and in providing patients with quality generics. Thus, the main mechanism for ensuring the availability of medicinal products and medical devices for the population is the reimbursement program – the complete or partial refunding to entities engaged in retail trade of medicinal products, of the cost of medicinal products or medical devices dispensed to patients based on prescriptions, at the expense of the State Budget of Ukraine. The main objective of regulatory activities remains comprehensive regulation. Individual healthcare questions, including the provision of medicinal products, have been explored in the works of Yu. Bytiak, V. Kolpakov, R. Maidanyk, O. Myronets, I. Seniuta and others. The purpose of this publication is to review the normative and legal regulation of the reimbursement mechanism and practical implementation issues. Different countries establish their own reimbursement mechanisms, which vary in terms of funding sources, reimbursement conditions, price regulation methods, selection criteria for medicinal products, and key nosologies for treatment. The recipients of such systems may include socially vulnerable segments of the population, individuals suffering from severe or chronic illnesses, as well as various types of pharmaceutical assistance such as inpatient and outpatient care. Depending on the specifics of healthcare systems in different countries, different compensation mechanisms may be used. For example, this may involve the reimbursement of the cost of medicines for insured individuals, where the patient’s treatment expenses are covered by the insurance company or compensated to pharmacy establishments, with settlements being made between the insurance fund, healthcare facility, and pharmacy based on contracts. In Ukraine, in the absence of a mandatory medical insurance system, the reimbursement process operates in the form of the state program «Accessible Medicines», where the state compensates pharmacy establishments for the full or partial cost of medicines from the respective list.

Analyzing Treatment Patterns for Neovascular Age-related Macular Degeneration with Expansion of the Korean Health Insurance Policy

Purpose: We analyzed the incidence and prevalence of neovascular age-related macular degeneration (AMD) and the treatment patterns of AMD in response to changes in health insurance policies in South Korea.Methods: We retrospectively analyzed the incidence and prevalence of neovascular AMD in patients diagnosed between 2010 and 2019. Data were extracted from the Korean National Health Insurance System database. The incidence and prevalence per 10,000 person-years and corresponding 95% confidence intervals were calculated. Furthermore, we recorded the usage of ranibizumab and aflibercept among newly diagnosed patients with neovascular AMD between 2010 and 2014.Results: In total, 90,012 patients were diagnosed with neovascular AMD between 2010 and 2019. The incidence of neovascular AMD increased with age, except for individuals aged ≥ 90 years. The prevalence of neovascular AMD increased significantly from 30.29 per 10,000 person-years in 2010 to 50.8 per 10,000 person-years in 2019. The rate of intravitreal ranibizumab injections decreased following the introduction of aflibercept in 2014. Patients who switched from ranibizumab to aflibercept exhibited a higher drug switch rate than those who switched from aflibercept to ranibizumab (28.83% vs. 8.40%). Among newly diagnosed patients, approximately 65% received treatment covered by the health insurance system. On average, six injections were administered per year between 2010 and 2019; the number of injections increased in accordance with the maximum limit supported by the government.Conclusions: The incidence and prevalence of neovascular AMD demonstrated an increasing trend. The treatment patterns are influenced by changes in government funding support policies. These findings provide valuable information for planning neovascular AMD treatment.

Review of frequently used Kampo prescriptions: Part 4, Ninjin'yoeito

AbstractBackgroundThe source of ninjin'yoeito (NYT) is considered the ‘Formulary of Bureau of Taiping People's Welfare Pharmacy’, written around 1241–52 AD. NYT is used to treat patients with chronic fatigue, malaise with qi deficiency, and exhaustion of all five parenchymatous viscera with difficulty in recovering.Key FindingsNYT formula consists of 12 crude drugs. NYT extract for medical use is covered by the National Health Insurance system of Japan for convalescence after recovery from diseases, fatigue and malaise, anorexia, perspiration during sleep, cold limbs, and anemia. Studies have shown clinical effects of NYT: treatment of anemia, cancer treatment support, frailty, cognitive dysfunction, apathy, fatigue/malaise, anorexia, and lung diseases. Preclinical studies support clinical studies; activating ghrelin‐neuropeptide Y pathway‐mediated appetite‐enhancing effects, inhibiting muscle volume loss through the Akt/mTOR pathway‐mediated hyperphosphorylation of 4E‐BP1 and FoxO1‐mediated Atrogin‐1, suppressing the hypothalamic–pituitary–adrenal axis by downregulating the sympathetic‐adrenal‐medullary axis and GABA neurons for improving sociability, promoting recovery from skeletal muscle atrophy through the activation of PGC‐1α, hematopoiesis‐promoting effects, and increasing the number of immune cells in immunocompromised models. The incidence of adverse events of NYT was reported as 3.09 or 2.03%. The most significant adverse effects of NYT are gastrointestinal disorders.ConclusionRecently, NYT has been widely used to treat several symptoms and conditions under the National Health Insurance System of Japan. Clinical studies showed the efficacy of NYT to treat anemia, frailty, cognitive dysfunction, anorexia, apathy, and fatigue/malaise, as well as for long‐term cancer treatment support. The pharmacological mechanisms supporting its effects are also being reported.

A Study on National Health Insurance Literacy among International Students in Korea and Their Medical Service Use

This study aimed to examine international students’ perceptions, characteristics, use of public medical services, and satisfaction with the National Health Insurance System, and compared the results with the Health Insurance System Perception Survey conducted on Korean population to understand the differences between the two groups’ perceptions of the health insurance system and their use of medical services.A survey was conducted from May 23, 2022 to June 21, 2022 to measure various data of international students related to the National Health Insurance System and analyzed the results.Most international students were in their 20s (the average age was 23±2.06 years), which showed that they were less likely to use medical services compared to Korean population in their 20s. Both Korean population and international students viewed their subjective health as generally good. Regarding the perceptions of the National Health Insurance System, 75.6% of the Korean population responded positively, while only 16% of international students responded positively. The biggest reason for the negative responses was the higher contributions compared to private health insurance, showing that financial hardship played a large role in the negative perceptions. The insurance contribution calculation methods by the Government showed differences. International students receive the same insurance contributions regardless of their nationality, age, income, or assets.Through this study, it has been confirmed that further research and examination are needed regarding the application of Korean health insurance to foreign residents and the appropriate calculation of insurance contributions.

Smoking and cardiovascular outcomes after percutaneous coronary intervention: a Korean study.

The authors investigated the impact of smoking and its cessation after percutaneous coronary intervention (PCI) on cardiovascular outcomes. Using a nationwide database from the Korean National Health Insurance System, 74 471 patients undergoing PCI between 2009 and 2016 were classified as non-, ex-, or current smokers, depending on smoking status at the first health check-up within 1 year after PCI. The primary outcome was major adverse cardiovascular and cerebrovascular event (MACCE), a composite of all-cause death, myocardial infarction, coronary revascularization, and stroke. During 4.0 years of follow-up, current smokers had a 19.8% higher rate of MACCE than non-smokers [adjusted hazard ratio (aHR) 1.198; 95% confidence interval (CI) 1.137-1.263], and ex-smokers tended to have a comparable rate with that of non-smokers (aHR 1.036; 95% CI .992-1.081). For 31 887 patients with both pre- and post-PCI health check-up data, the effects of smoking cessation were analysed. Among quitters who stopped smoking after PCI, quitters with cumulative smoking exposure of <20 pack-years (PYs) tended to have a comparable rate of MACCE with that of persistent non-smokers. However, the rate in quitters with cumulative exposure of ≥20 PYs was comparable with that of persistent smokers [aHR (95% CI) for <10 PY, 1.182 (.971-1.438); 10-20 PYs 1.114 (.963-1.290); 20-30 PYs 1.206 (1.054-1.380); ≥ 30 PYs 1.227 (1.113-1.352); persistent smokers 1.223 (1.126-1.328), compared with persistent non-smokers, respectively, P for interaction <.001]. Smoking is associated with a higher risk of adverse outcomes in patients undergoing PCI. Quitters after PCI with <20 PYs were associated with a risk comparable with that of non-smokers.

The road to recovery: impact of COVID-19 on healthcare utilization in South Korea in 2016–2022 using an interrupted time-series analysis

The COVID-19 pandemic substantially disrupted healthcare utilization patterns, globally. South Korea had been praised widely in its efforts to contain the spread of the pandemic, which may have contributed to a significantly smaller reduction in healthcare utilization compared to neighboring countries. However, it remains unknown how the COVID-19 pandemic impacted utilization patterns across population sub-groups, particularly vulnerable patient groups in South Korea. This paper quantifies the changes in healthcare utilization attributable to COVID-19 and the COVID-19 vaccination by sub-groups. An interrupted time series analysis was conducted to examine the impact of COVID-19 on healthcare utilization in South Korea from January 2016 to December 2022 using aggregated patient-level data from the national health insurance system that accounts for 99% of all healthcare services in South Korea. We applied negative binomial models adjusting for seasonality and serial correlation. Falsification tests were conducted to test the validity of breakpoints. Stratified analyses by type of healthcare services, age, sex, income level, health facility type, and avoidable/non-avoidable hospitalizations was performed, and we assessed differences in utilization trends between population groups across three phases of the pandemic. In early 2020, the COVID-19 pandemic caused a reduction in monthly volume of outpatient utilization by 15.7% [95% CI 13.3%-18.1%, p<0.001] and inpatient utilization by 11.6% [10.1%-13.0%, p<0.001]. Most utilization recovered and rebounded to pre-COVID-19 levels as of December 2022 although variations existed. We observed heterogeneity in the magnitude of relative changes in utilization across types of services, varying from a 42.7% [36.8%-48.0%, p<0.001] decrease for pediatrics, a 23.4% [20.1%-26.5%%, p<0.001] reduction in utilization of public health centers, and a 24.2% [21.2%-27.0%, p<0.001] reduction in avoidable hospitalizations compared to the pre-pandemic period. Contrary to global trends, health utilization among the elderly population (65 and older) in South Korea saw only marginal reductions compared to other age groups. Similarly, Medicaid patients and lower income groups experienced a smaller reduction compared to higher income groups. The impact of the COVID-19 pandemic on healthcare utilization in South Korea was less pronounced compared to the global average. Utilization of vulnerable populations, including adults over 65 years old and lowest-income groups reduced less than other type of patients. No funding.