South Korean Healthcare System Research Articles

Association of Primary Care Physician Supply with Population Mortality in South Korea: A Pooled Cross-Sectional Analysis.

Primary care physicians perform a comprehensive role by providing continuous, patient-centered, and accessible healthcare and establishing connections with specialized care. However, the association between the supply of primary care physicians and mortality rates in South Korea has not been thoroughly investigated. This study utilized data from 229 si-gun-gu in South Korea from 2016 to 2020. The densities of primary care physicians, physicians in functional primary clinics, specialists in primary care facilities, and active physicians per 100,000 people were independent variables. Age-adjusted all-cause mortality and cause-specific mortality rates per 100,000 individuals were the dependent variables. Negative binomial regression, negative binomial regression with a pseudo-panel approach, and geographically weighted regression were used to analyze the data. Our study revealed a significant negative association between the density of primary care physicians and all-cause mortality. An increase in a primary care physician per 100,000 population was significantly linked to a 0.11% reduction in all-cause mortality (incidence rate ratio, 0.9989; 95% confidence interval, 0.9983-0.9995). Similar associations have been observed between mortality rates owing to cardiovascular diseases, respiratory tract diseases, and traffic accidents. This study provides evidence that having a higher number of primary care physicians in South Korea is associated with lower mortality rates. Future research should consider better indicators that reflect the quality of primary care to better understand its impact on population health outcomes. These findings emphasize the significance of strengthening primary care in the South Korean healthcare system to improve the overall health and wellbeing.

의사-한의사 복수면허자의 진로 선택, 학습 경험 및 업무 경험에 관한 질적 연구

This study investigates the experiences of individuals holding dual medical licenses, including both medical doctor and Korean Medicine (KM) doctor licenses. The study examines their motivations for obtaining dual licenses, their study and work experiences, and their relationships with fellow students and physicians. The objective of the study is to gain insight into how dual license holders establish their identities in the South Korean medical system, which is strictly divided into modern and traditional sectors. To achieve this objective, a qualitative interview survey was conducted with six multiple licensees of medical doctors and KM doctors. The data indicate that interview participants were interested in obtaining multiple licenses either before, immediately after, or long after completing their first medical schools. During the process of acquiring multiple licenses, respondents recognized differences between biomedicine and traditional Korean medicine, and encountered conflicts between medical doctors and KM doctors in their learning process and relationships with their professors and fellow physicians. In this process, it can be observed that dual license holders are often required to choose between their Western medical identity and their KM identity, in situations where conflicts arise between Western medical doctors and KM doctors. Consequently, they may face challenges in fully utilizing their medical skills within the South Korean healthcare system. Unlike previous studies that relied on quantitative analysis, this study provides a comprehensive understanding of how the lives and experiences of medical holders of both medical doctor and KM doctor licenses are linked to the characteristics of the Korean medical system, from the perspective of medical pluralism.

Cost-Effectiveness of Clopidogrel vs Aspirin Monotherapy After Percutaneous Coronary Intervention: Results From the HOST-EXAM Study

BackgroundThe HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Disease–Extended Antiplatelet Monotherapy) trial showed superior efficacy and safety of clopidogrel monotherapy compared with aspirin monotherapy during the chronic maintenance period after percutaneous coronary intervention (PCI). ObjectivesThe goal of this study was to investigate the cost-effectiveness of clopidogrel monotherapy compared with that of aspirin monotherapy. MethodsA Markov model was developed for patients in the stable phase after PCI. From the perspectives of the South Korean, UK, and U.S. health care systems, the lifetime health care costs and quality-adjusted life-years (QALYs) of each strategy were estimated. Transition probabilities were obtained from the HOST-EXAM trial, and health care costs and health-related utilities were obtained from data and literature for each country. ResultsFrom the perspective of the South Korean health care system, the base-case analysis showed that clopidogrel monotherapy was $3,192 higher in lifetime health care costs and 0.139 lower in QALYs compared with aspirin. This result was greatly influenced by the numerically but insignificantly higher cardiovascular mortality of clopidogrel compared with aspirin. In the analogous UK and U.S. models, clopidogrel monotherapy was projected to decrease health care costs by £1,122 and $8,920 per patient compared with aspirin monotherapy while reducing QALYs by 0.103 and 0.175, respectively. ConclusionsBased on empirical data from the HOST-EXAM trial, clopidogrel monotherapy was projected to lead to reduced QALYs compared with aspirin during the chronic maintenance period after PCI. These results were affected by a numerically higher rate of cardiovascular mortality in clopidogrel monotherapy reported from the HOST-EXAM trial. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis–Extended Antiplatelet Monotherapy [HOST-EXAM]; NCT02044250)

Patient Perspectives of Chronic Disease Management and Unmet Care Needs in South Korea: A Qualitative Study.

Understanding and incorporating patients' perspectives are necessary to address the emerging challenge of chronic disease management. Our study examined patients' perceptions and experiences for the current chronic disease management system in South Korea. Focus group interviews were conducted on 23 patients and 11 themes emerged by qualitative content analysis. The participants experienced in terms of provider-patient interaction: doctors only prescribe medicine, doctors who provide conventional advice, doctors who do not respect the patients' opinion, long wait times and inadequate consultations, lack of personalized care, and freedom to select another doctor. They also experienced in their community and health system: struggling alone, commercial media and folk remedies, lack of IT technologies for care, demanding visiting services, and lack of collaboration in the community. We found that patients needed comprehensive and personalized care, respect from providers, and self-management support and collaborated care with the community using information technologies advancement. Our findings suggest that a fundamental change in the South Korean healthcare system paradigm is required for successful chronic care, including payment and healthcare delivery systems.

해방 이후 남북한 보건의료환경의 변화와 월남의사의 정착

North Korean doctors who chose to move to the South symbolized certain shifts that had earlier occurred in the respective environments of South and North Korean medical care systems. In case of North Korea, right after the Liberation the authorities nationalized healthcare, and implemented Thought control(Censorship) on doctors. That prompted them to consider breaking free from the regime, while their knowledge of the healthcare condition in the south also factored into their decision to move to South Korea.BR At the time, South Korean healthcare system was deteriorating. It was in dire need of professionally trained medical personnel. South Korean authorities chose not to authorize various (and more traditional) medical practitioners, causing the demand on regular doctors to rise, while the overall increase in medical cost ensured wealthy life for certified doctors. All these factors made the South Korean environment all the more appealing to the “liberalist” North Korean doctors, and in the post-Liberation period their exodus to the South continued. Ever since the end of the Korean War, somewhere between 300 and 400 doctors moved to the South, enriching the pool of authorized medical practitioners in South Korea.BR Yet the fate of North Korean doctors who arrived in the south varied, as even after they safely touched down in South Korea, their expertise had to be verified and their practices needed authorization. Even the ones who got certification as regular doctors experienced some difficulties. They pleaded the government through alumni meetings to resolve the issue of doctor qualification, while also applying for exams and successfully passing them. Other medical practitioners also tried to resolve their issues through group lobbies, but the ones who were never able to have their expertise and practices authorized, were only absorbed into the South Korean society.

Incidence and prevalence of pressure ulcers in hospitals: 10-year cohort study.

Pressure ulcers (PUs) are a serious problem in patients with multiple comorbidities and are associated with a longer duration of hospital stay and higher medical costs. The aetiology and rate of PU occurrence in South Korea remains unclear. Therefore, we aimed to determine the incidence, prevalence, mortality and common comorbidities of hospitalised patients with PUs in the South Korean healthcare system. A 10-year cohort study using the healthcare insurance reimbursement claims from the South Korean National Health Insurance System database. Patients diagnosed with a PU on admission to hospital [ICD-10: L89 + procedure code] between January 2002 and December 2016 were included and their comorbidities evaluated. Patients <20 years of age and recurrent PU cases were excluded. Incidence, prevalence, survival rate and risk factors related to survival rate of patients with PUs were determined. The study population in 2006 was 36,195,121 (all patients admitted to hospital that year), which changed yearly because of the inclusion of additional patients who met the study inclusion criteria, and removal of patients who had died during the year. Standardised PU incidence rate decreased from 17.1 in 2006 to 14.9 in 2015 per 10,000 people. Standardised PU prevalence also showed a slightly decreasing trend from 20.2 in 2006 to 18.9 in 2015 per 10,000 people. This findings of this 10-year study showed that incidence and prevalence of PUs markedly increased with age after the seventh decade. Incidence of PUs increased in patients with pneumonia, cerebral infarction, sepsis, femoral neck fracture and malignant neoplasm of the bronchus. Patients with femoral neck fracture and cerebral infarction showed a higher rate of survival than those with other high-risk comorbidities.

Mirabegron has longer treatment persistence than antimuscarinics:Real-world data from a Korean national cohort database.

To descriptively evaluate treatment persistence among adults who received mirabegron or antimuscarinics in South Korea. This study involved a retrospective analysis of the Health Insurance Review and Assessment (HIRA) database. Patients (≥18 years) who had a new prescription for an overactive bladder (OAB) target medication (mirabegron/antimuscarinic) within an 8-month index period (July 1, 2015-February 29, 2016) were included. The date when the target (index) medication was dispensed was the index date. The 6-month period before the index date was used to assess patient eligibility. A 12-month post-index period was used to assess medication persistence, which was defined as the time to discontinuation. Overall data were analyzed and the results were also stratified by age group (≤65, >65 years), sex, or prior OAB medication experience. Persistence rates were calculated after the 1st, 3rd, 6th, 9th, and 12th months. A data set of 52 722 cases was obtained (mirabegron: 11 424, antimuscarinics: 41 298). The mean age was 60.9 ± 16.1 years and the majority of the patients were female (30 862 [58.5%] patients). Median persistence was longer with mirabegron (51 days) versus antimuscarinics (25 days). The persistence rate with mirabegron was higher throughout the study compared with all the antimuscarinics (12-month data: 13.5% and 4.9%, respectively). Longer treatment persistence was noted in older, male, and treatment-experienced patients. The results from the HIRA database showed that persistence was longer with mirabegron than with antimuscarinics in South Korea. This finding may help inform clinical decision-making within the South Korean healthcare system.

Strategies for reducing hospital nurse turnover in South Korea: Nurses' perceptions and suggestions.

To explore the South Korean nurses' perspectives on the current hospital working conditions in order to identify causes of persistent high turnover rates among the nurses. High turnover rates of hospital nurses continue to pose a serious challenge to South Korean health care system despite the government's recent efforts to improve working conditions. Many studies in the past had examined factors related to the turnover and provided only a partial understanding of turnover predictors. However, nurses' perceptions on the current working conditions must be considered to explore possible causes of continued high turnover, to identify solutions and to improve working conditions by addressing nurses' concerns. This study is a qualitative study using focus group interviews with 33 nurses from 11 South Korean hospitals. Three main themes and eight subthemes related to reducing hospital nurse turnover were identified. To address hospitals' nursing shortages in South Korea, it is important to address poor work environments. This study showed that more transformational policies should be developed and implemented to change working conditions by reducing excessive workloads and improve how nurses are treated and viewed so as to retain existing nurses and ease the nurse turnover rates.

Is Korea Prepared for an Alzheimer's Disease-Modifying Therapy? Assessing the Korean Healthcare System Infrastructure and the Effect of Blood-Based Biomarker Tests.

BackgroundWith the rapid demographic change in Korea, Alzheimer’s disease has become a primary concern. Recent developments in disease-modifying therapies provide hope that therapy may become available soon. The high disease prevalence and complex evaluation process will create challenges for the healthcare system already burdened by the current pandemic. This study examined the preparedness of the South Korean healthcare system to identify and treat patients when such a therapy becomes available.MethodsWe used a Markov model to simulate a stylized patient’s journey. Based on national data and expert input, we presented projections of the diagnosis and treatment wait times and respective queues of patients under treatment and no-treatment scenarios and further simulated the possible option of adopting a blood-based biomarker test. ResultsUnder the current system, we estimated a peak waiting time of 14 months when a treatment became available, largely because of the limited number of dementia specialists. Adopting a blood-based biomarker test dramatically reduced the initial wait times by more than half. A disease-modifying therapy was estimated to avert 575,000 incident cases in the first 10 years after the treatment entered the market, and a blood-based test further avoided 86,000 additional cases.ConclusionSouth Korea’s healthcare infrastructure requires more preparation for the introduction of a disease-modifying therapy, with the primary capacity limitation being the low number of dementia specialists. The utilization of a blood-based test for Alzheimer’s disease biomarkers may be an effective solution.

Depression in North Korean refugees: a mixed methods study

ObjectiveThe objective of this study is to investigate beliefs and experiences about depression in North Korean refugees (NKRs) using both quantitative and qualitative methods. Study designWe used an exploratory sequential mixed methods study design with a quantitative survey followed by an in-depth individual interview. MethodsWe surveyed 329 NKRs who had been in South Korea for at least a year. Eleven participants were selected from the survey sample to complete an additional individual in-depth interview to obtain further understanding about depression among NKRs in their own words and context. ResultsAbout 44% of the sample had mild to severe depression; only 16% indicated that they were being treated for mood disorder. Individual in-depth interviews yielded key themes related to NKRs’ depression beliefs and experiences: recognizing depression, factors contributing to depression, overcoming depression, and barriers to seeking help and treatment. Integration of quantitative and qualitative data revealed that although loneliness was one of the prominent subthemes contributing to depression, strong self-determination was noted as being critical to overcoming depression among those who had moderate to moderately severe depression but had no social support. ConclusionsFuture efforts should be directed toward an enhanced support network and targeted education about the South Korean healthcare system, particularly in relation to mental health treatment.

Universal but Precarious: A Case Study of the South Korean Health Care System

Since its inception in 1977, the development of the National Health Insurance system in South Korea took the world by surprise. In 2001, South Korea introduced a single-payment system. However, in spite of the advancements made in medical technology and services and the fact that the National Health Insurance system covers the whole population, its citizens are seemingly still insecure and often experience precariousness with regard to their health coverage. It is ironic that despite the nearly 100% population coverage, many South Koreans also purchase private health insurance because of their anxiety about the limited coverage of the National Health Insurance benefit package. Even though the health care system in South Korea displays symptoms of precariousness, there is still no academic research that analyzes this concept as an approach to understanding the challenges that face the system. In this study, we examine the suitability of applying three attributes of precariousness, namely uncertainty, disempowerment, and insecurity (both financial and institutional), previously researched in the employment sector, to the health system to analyze how South Koreans experienced them and to explain the precariousness of the health care system at both the individual and institutional levels.

OP64 Economic Impact Of Cardiac Device Remote Monitoring In South Korea

INTRODUCTION:The reduction of healthcare costs and societal cost due to remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been demonstrated in several countries; however, to the best of our knowledge it does not exist for South Korea. This work aims at providing an estimation of the potential benefit of RM versus standard care (SC) of CIEDs in term of healthcare costs in South Korea, in order to provide additional substance to the currently ongoing societal debate about the value of telemedicine.METHODS:Healthcare resource consumption was taken from the results of the TARIFF study, a prospective, non-randomized, multicenter clinical trial designed in Italy to assess the economic benefits of RM follow-up in comparison with standard follow-up in 209 patients (107 SC, 102 RM). The main results demonstrated that RM reduced healthcare resource consumption by 54 percent from a healthcare services perspective (SC: EUR1,044.89±1,990.47 versus RM: EUR482.87±2488.10, p&lt;.0001 (1).In order to perform a cost analysis from the perspective of the South Korean healthcare payer, the following unit costs were assigned to resources collected in TARIFF (hospitalizations, visits, examinations): fee-for-service tariffs, emergency tariffs and outpatient tariffs. Remote follow-up costs were considered as zero.RESULTS:From the perspective of the South Korean healthcare payer, the overall mean annual cost/patient in the RM group is 53 percent lower than in SC group (SC: EUR405,439±40,135 versus RM: EUR189,96±725,52, p&lt;.0001) (SC: KRW 497,145±49,2137 versus RM: KRW 232,936±890,181, p&lt;.0001). This is mainly due to a significant cost reduction in device-related hospitalizations, examination tests and visits in the follow-up period.CONCLUSIONS:RM of CIED patients is cost-saving from the perspective of the South Korean healthcare system. Introducing appropriate reimbursement for remote monitoring of CIED is not likely to change this result and should make RM sustainable for the provider and encourage widespread adoption of RM.

Economic evaluation of eribulin as second-line treatment for metastatic breast cancer in South Korea.

BackgroundMetastatic breast cancer (MBC) is associated with poor prognosis, particularly for those patients with human epidermal growth factor receptor (HER2)-negative tumor. Similar to the rest of the world, treatment options are limited in South Korea following first-line chemotherapy with anthracyclines and/or taxanes. This study examined the cost-effectiveness and cost-utility of eribulin in South Korean patients with HER2-negative MBC who have progressed after usage of at least one chemotherapeutic regimen for advanced disease (second-line therapy).MethodsA partition survival model was developed from the perspective of the South Korean health care system. The economic impact of introducing eribulin as second-line therapy for HER2-negative MBC was compared to that of capecitabine and vinorelbine. The analysis estimated incremental cost per life-year (LY), that is, cost-effectiveness, and cost per quality-adjusted life-year (QALY), that is, cost-utility, of eribulin for management of HER2-negative MBC in South Korea. The model accounted for overall survival, progression-free survival, drug costs, grade 3/4 adverse events, and health care utilization. Deterministic and probabilistic sensitivity analyses were performed to identify uncertainty in the results of the economic evaluation.ResultsSecond-line eribulin was associated with greater benefits in terms of LY and QALY, compared to capecitabine and vinorelbine. The incremental cost-effectiveness ratio was ₩10.5M (approximately USD 9,200) per LY, and the incremental cost-utility ratio was ₩17M (approximately USD 14,800) per QALY in the basecase analysis. The incremental cost-utility ratio ranged from ₩12M (USD 10,461) to ₩27M (USD 23,538) per QALY in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, >99% of the simulations were below ₩50M (USD 42,300), and the lower and upper 95% confidence intervals were ₩3M (USD 2,600) and ₩24M (USD 20,900) per QALY, respectively.ConclusionThere currently exist a limited number of treatment choices for women with HER2-negative MBC. Eribulin is a cost-effective option for second-line therapy in South Korea and should be added to the current indications for reimbursement.

A Comparison of the Cambodian and the South Korean Health Care System.

The comparison of the healthcare system between these two countries, we can obviously see the health status in South Korea is much better than in Cambodia which has been fighting against communicable diseases such as tuberculosis, malaria, HIV/AIDS, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).4 In order to improve the quality of healthcare in Cambodia, MOH has overall responsibility of the health sector, including: policies, legislation, strategic planning, resource mobilization and allocation, monitoring, evaluation, research, providing training to support the provinces, and coordination of external aid. The MOH's main objective in health sector reform has been to improve and extend primary health services through the implementation of the operational districts system.

A Comparison of the Danish and the South Korean Health Care System.

The Danish people have always been very proud of the Danish health system. Even in the early years of the Danish history the country was known for its long living people. The Danish health system is very well structured and it is based on the idea of giving every citizen the opportunity of free health care. About 15.5% of the economic support of the Danish health system is paid by the citizens through general taxes - therefore the Danish taxes are quite high compared to other European countries but the Danish citizens are then able to have medical treatment, operations and medicine for free at any time. In Denmark, we divide our health care system into two groups, the primary health care system and the secondary health care system. The primary system include the general practitioner, the pharmacies, the dentists, the nursing homes for elderly people or disable, and the home based care of elderly people or newborns. The secondary system is the hospitals, as well as the specialized clinics. To use the secondary system, you would need a referral slip from the general practitioner, but there are some specialties that you are allowed to use without the referral slip - for example the otho-rhino-laryngologie. You can also go to the hospital in case of emergency or childbirth without the slip. In the primary system you are connected to one doctor (one general practitioner), who works at a private clinic. The government pays the doctor and the clinic an arranged amount of money for each consultation they proceed. The only thing you have to pay for yourself are the dentists. In the secondary system you can choose freely among the hospitals in Denmark. Most of the hospitals in Denmark are public so you don’ t need to pay for the treatment, the admission or even the surgeries if needed. There are private hospitals as well in Denmark, but they are not used that often for illness. Typically only if the waiting list is too long for an operation or the patient wants a special treatment. Most of the patients at the private hospitals are there for cosmetic reasons, why plastic surgeries are big here. The primary system handles the smaller and more common illnesses, where the secondary system is for longer and more serious illnesses. In many

EARLY ASSESSMENT AND PREDICTION OF POTENTIAL IMPACT OF THE IMPLANTATION OF POLYURETHANE SCAFFOLD IN PARTIAL MENISCAL LESIONS: A PILOT HORIZON SCANNING ACTIVITY IN SOUTH KOREA.

The aim of this study was to predict the potential impact of the introduction of implantation of polyurethane scaffold for the treatment of partial meniscal lesions in the South Korean healthcare system. The horizon scanning process was used to select a target technology and assess its potential impacts on patients and the Korean healthcare system. We identified and filtered research-phase health technologies that are not listed yet in Korean, but appear promising. After a process of prioritization, we chose the implantation of polyurethane scaffolds as a target technology. Then, through the procedures of assessment and peer review, we analyzed current evidence and its predicted potential impacts. There were eight studies included in the review: one prospective cohort and seven case-series studies. Six revealed significant improvements in function and pain relief. Of the six studies, which reported safety endpoints, four stated no major postoperative complications related to scaffold, and two reported adverse events and serious adverse events such as pain, joint swelling, et cetera. We also included the potential impact of this technology based on the experts' consultation. They all agreed that it would satisfy the diverse needs of patients and fulfill clinical needs. However, the majority of related clinical studies were based on short-term follow-up observations without any validation process involving comparison with control groups. Through a horizon scanning activity, we found that the implantation of polyurethane scaffolds is a promising technology to resolve articular cartilage defects; however, long-term evidence with comparison groups for safety and effectiveness is required.

Performance of Universal Health Insurance: Lessons from South Korea

The aim of this study was to assess the maturity of the South Korean healthcare system in comparison with those of the 30 countries of the Organization for Economic Co-operation and Development (OECD) and to provide a foundation to evaluate the performance of the South Korean healthcare system. Using OECD Health Data 2005, we evaluated the performance of the healthcare system of the 30 industrialized countries. The evaluation focused on three dimensions that have remained central to healthcare debates internationally for years: access, cost and outcomes. Although South Korea has successfully implemented its universal health insurance scheme in a very short period of time and possesses highly advanced medical technologies, we found that South Koreans incurred more out-of-pocket expenditures on healthcare. Health outcomes were of relatively low quality compared with those of other OECD countries, but compared relatively well with the four countries (Greece, New Zealand, Portugal and Spain) with similar per capita gross domestic product (GDP).

Cost of Chronic Hepatitis B Infection in South Korea

To estimate the direct medical costs of chronic hepatitis B (CHB) infection and its liver disease sequelae in South Korea. Korea is a hepatitis B-endemic area with 5.79% to 10.87% of males and 1.51% to 4.44% of females over 20 years of age carrying the virus. It is estimated that 25% of carriers will develop serious hepatitis B virus (HBV)-related complications. While vaccination programs have reduced the prevalence of hepatitis B in people younger than 20 years, significant CHB-related morbidity will continue to occur for the next 15 to 30 years until the benefits of the vaccination programs take effect. Direct medical costs for six CHB-related disease states, including hepatocellular carcinoma and liver transplant, were estimated for the year 2001. Four data sources were used to gather information: the National Health Insurance Corporation database, patients' medical charts, expert opinion, and patient survey data. In 2001, the total medical costs of six CHB-related diseases were 250 million Korean Won (KRW) (equivalent to U.S. 208.6 million dollars), based on an exchange rate of KRW 1200 = US 1 dollar. Annual treatment costs per patient ranged from KRW297,392 (US 248 dollars) for chronic hepatitis B to KRW 80.6 million (U.S. 67,156 dollars) for liver transplant. The cost of treatment rose continuously with liver disease progression. The main cost driver was inpatient hospitalizations (including surgical costs). CHB-related diseases are a significant cost burden to the South Korean healthcare system. In addition to the obvious clinical benefits, the prevention or delay of chronic hepatitis B liver disease progression in South Korea could result in substantial economic benefits to the whole society.

Economic evaluation of the societal costs of hepatitis B in South Korea.

Hepatitis B (HBV) infection remains a major public health problem in South Korea, and accounts for considerable morbidity and mortality. At present, very little is known about the cost of HBV to the South Korean health-care system and society. The present study was therefore conducted to estimate the total annual cost of HBV infection in South Korea for a given year (1997). The study was conducted from the South Korean societal perspective, taking into account the direct and indirect costs of HBV vaccination programs (prevention costs), and those related to the treatment of acute and chronic hepatitis, cirrhosis and liver cancer (disease costs). Several assumptions were made in arriving to actual cost estimates. The total societal cost of HBV in 1997 was 1078.3 billion Won ($US 959.7 million), 142.3 billion Won or 13.2% being attributable to prevention costs and 225.4 billion Won or 20.9% being attributable to indirect costs of HBV-related diseases. The total cost (direct plus indirect) associated with HBV-related diseases to the South Korean society was 936.1 billion Won ($US 833.1 million), of which 45.3% was attributable to cirrhosis-related costs. In terms of disease-related direct costs alone (710.5 billion Won or $US 632.3 million), the estimated annual spending per patient was 1.37 million Won ($US 1219). The direct costs of the HBV disease (prevention and disease treatment, amounting to 782.2 billion Won or $US 696.2 million) is equivalent to 3.2% of the national health-care expenditure for 1997. This study confirms that HBV is a significant cost burden to the South Korean society, and in the absence of an effective cure reinforces the importance of continued disease prevention via vaccination.