The purpose of this study was to analyze the medical cost of facial paralysis in payer perspective and to estimate the practice pattern of patient using 2011 Health Insurance Review & Assessment Service-National Patients Sample(HIRA-NPS).
Methods:
Basic statistical system was used for descriptive analysis of NPS dataset. A table for general information (table20) was extracted by disease code, and social demographic characteristics, distribution of the use among inpatients and outpatients, utilization of each kind of medical care institutions, medical cost were analyzed. Subgroup analysis was conducted for assuming the practice pattern of korean medicine and western medicine.
Results:
A total of 8,219 people and 64,345 claims data were identified as having facial paralysis. Proportion of outpatient was 95.23%, inpatient 0.84% and patient using both services 3.93%. Mean patient charges was 44,229 won per outpatient, 178,886 won per inpatient and 523,542 won per patient using both services. Utilization of korean medical care institutions was 68.81%(claims), 40.46%(patients), utilization of western medical care institutions was 31.19%(claims), 59.54%(patients). The amount charged by korean medical care institutions was 52.61% and western medical care institutions was 47.39%. Cost per claim was higher than those of the korean treatment and cost per patient of western treatment was lower than those of the korean treatment.
Conclusions:
The research assessed the medical cost and practice pattern associated with facial paralysis. These findings could be used in health care policy and subsequent studies.
Average cost of the claims data based on medical care institutions
Table 1.
ICD-10 for analysis
ICD-10
설명
G51
안면신경장애(Facial nerve disorders)
G51.0
벨마비(Bell’s palsy), 안면마비(Facial palsy)
G51.1
슬신경절염(Geniculate ganglionitis)
G51.2
멜커슨 증후군(Melkersson’s syndrome)
G51.3
간대성 반쪽얼굴연축(Clonic hemifacial spasm)
G51.4
안면근육파동증 (Facial myokymia)
G51.8
기타 안면신경장애(Other disorders of facial nerve)
G51.9
상세불명의 안면신경장애(Disorder of facial nerve, unspecified)
G53
달리 분류된 질환에서의 뇌신경 장애(Cranial nerve disorders in diseases classified elsewhere)
G53.0
대상포진후 신경통(B02.2+)(Postzoster neuralgia)
포진후 삼차신경통(Postherpetic trigeminal neuralgia)
포진후 슬신경절염(Postherpetic geniculate ganglionitis)
G53.1
달리 분류된 감염성 및 기생충성 질환에서의 다발성 뇌신경마비(A00-B99+)(Multiple cranial nerve palsies in infectious and parasitic diseases classified elsewhere)
G53.2
사르코이드증에서의 다발성 뇌신경마비(D86.8+)(Multiple cranial nerve palsies in sarcoidosis)
G53.3
신생물질환에서의 다발성 뇌신경마비(C00-D48+)(Multiple cranial nerve palsies in neoplastic disease)
G53.8
달리 분류된 기타 질환에서의 기타 뇌신경장애(Other cranial nerve disorders in other diseases classified elsewhere)
P11.3
안면신경의 출산손상(Birth injury to facial nerve)
Q87.0
주로 얼굴 형태에 영향을 주는 선천기형증후군(Congenital malformation syndromes predominantly affecting facial appearance)
Table 2.
The gender distribution of the sample patients
gender
number of sample patients
percentage(%)
male
2,963
36.29
female
5,201
63.71
Table 3.
The age distribution of the sample patients
age
number of sample patients
percentage(%)
0∼5세(1)
14
0.17
6세∼10세(2)
19
0.23
11세∼15세(3)
69
0.85
16세∼20세(4)
101
1.24
21세∼25세(5)
124
1.52
26세∼30세(6)
204
2.5
31세∼35세(7)
306
3.75
36세∼40세(8)
408
5
41세∼45세(9)
522
6.39
46세∼50세(10)
749
9.17
51세∼55세(11)
1064
13.03
56세∼60세(12)
948
11.61
61세∼65세(13)
872
10.68
66세∼70세(14)
939
11.5
71세∼75세(15)
840
10.29
76세∼80세(16)
985
12.07
Table 4.
Frequency analysis of ICD-10
ICD-10
number of claims data
percentage(%)
number of sample patient
percentage(%)
G51
50,864
79.05
4,838
58.86
G530
13,435
20.88
3,365
40.94
G532
1
0
1
0.01
G538
18
0.03
11
0.13
P113
4
0.01
1
0.01
Q870
23
0.04
3
0.04
Table 5–1.
Clinic frequency analysis of claims data
clinic
number of claims data
percentage (%)
department of korean internal medicine
27,712
43.07
department of acupuncture & moxibustion
15,625
24.28
department of neurology
9,282
14.43
dermatology
2,003
3.11
neurosurgery
1,879
2.92
anesthesiology
1,828
2.84
department of internal medicine
1,748
2.72
rehabilitation medicine
604
0.94
oriental neuropsychiatric
548
0.85
family medicine
505
0.78
general surgery
406
0.63
otorhinolaryngology
398
0.62
urology
372
0.58
division of korean ophthalmology, otolaryngology and dermatology
349
0.54
general
241
0.37
orthopedics
231
0.36
korean rehabilitation medicine
131
0.20
emergency medicine
121
0.19
ophthalmology
102
0.16
obstetrics and gynecology
53
0.08
plastic surgery
46
0.07
pediatrics
43
0.07
korean emergency medicine
23
0.04
radiology
20
0.03
division of sasang constitution
19
0.03
thoracic and cardiovascular surgery
13
0.02
neuropsychiatry
12
0.02
korean oriental pediatrics
10
0.02
oral medicine
7
0.01
oriental obstetrics & gynecology
7
0.01
conservative dentistry
3
0.00
oral and maxillofacial surgery
2
0.00
laboratory medicine
1
0.00
industrial medicine
1
0.00
Table 5–2.
Clinic frequency analysis of sample patients
clinic
number of sample patients
percentage (%)
department of neurology
2,297
27.95
department of korean internal medicine
1,876
22.83
department of acupuncture & moxibustion
1,359
16.53
dermatology
674
8.2
department of internal medicine
438
5.33
neurosurgery
375
4.56
anesthesiology
298
3.63
family medicine
146
1.78
urology
121
1.47
otorhinolaryngology
100
1.22
general surgery
92
1.12
rehabilitation medicine
74
0.9
division of korean ophthalmology, otolaryngology and dermatology
61
0.74
orthopedics
53
0.64
emergency medicine
53
0.64
general
45
0.55
oriental neuropsychiatric
40
0.49
ophthalmology
27
0.33
korean rehabilitation medicine
25
0.3
pediatrics
12
0.15
plastic surgery
11
0.13
obstetrics and gynecology
6
0.07
neuropsychiatry
5
0.06
korean oriental pediatrics
5
0.06
korean emergency medicine
5
0.06
radiology
4
0.05
oriental obstetrics & gynecology
4
0.05
conservative dentistry
3
0.04
division of sasang constitution
3
0.04
thoracic and cardiovascular surgery
2
0.02
oral and maxillofacial surgery
2
0.02
oral medicine
2
0.02
laboratory medicine
1
0.01
Table 6.
Analysis of medical cost based on claims data and sample patients
Analysis of medical cost based on claims data (unit: won)
Sum
Mean
S.D.
Median
burden of payer
1,356,517,460
21,082
97,280
12,810
burden of patient
527,625,770
8,200
32,926
4,500
sum of medical care expenses
1,891,540,000
29,397
127,644
15,970
Analysis of medical cost based on sample patients (unit: won)
Sum
Mean
S.D.
Median
burden of payer
1,356,517,460
165,047
403,652
36,940
burden of patient
527,625,770
64,196
153,875
13,200
sum of medical care expenses
1,891,540,000
230,142
546,781
51,710
Table 7.
Practice pattern of sample patients
practice pattern
number of sample patient
percentage(%)
outpatient
7,827
95.23
inpatient
69
0.84
inpatient·outpatient
323
3.93
sum of sample patients
8,219
100.00
Table 8.
Analysis of medical cost based on the inpatient claims data and outpatient claims data
medical cost of inpatient claims data (unit : won)
Sum
Mean
S.D.
Median
burden of payer
390,106,410
700,371
764,091
508,970
burden of patient
116,856,820
209,797
227,653
162,850
sum of medical care expenses
508,085,650
912,183
978,034
683,240
medical cost of outpatient claims data (unit : won)
Sum
Mean
S.D.
Median
burden of payer
966,411,050
15,150
19,813
12,770
burden of patient
410,768,950
6,440
16,848
4,500
sum of medical care expenses
1,383,454,350
21,688
35,115
15,970
Table 9.
Analysis of medical cost based on the inpatient and outpatient
medical cost of outpatient (N=7,827)
Sum
Mean
S.D.
Median
burden of payer
852,220,060
108,882
213,095
33,300
burden of patient
346,178,570
44,229
90,428
12,400
sum of medical care expenses
1,203,941,820
153,819
291,766
46,410
medical cost of inpatient (N=69)
Sum
Mean
S.D.
Median
burden of payer
45,630,040
661,305
879,131
502,540
burden of patient
12,343,140
178,886
322,683
84,830
sum of medical care expenses
58,201,420
843,499
1,185,622
636,110
medical cost of inpatient·outpatient (N=323)
Sum
Mean
S.D.
Median
burden of payer
458,667,360
1,420,023
1,087,294
1,080,530
burden of patient
169,104,060
523,542
399,248
424,390
sum of medical care expenses
629,396,760
1,948,597
1,442,195
1,594,550
Table 10.
Utilization of each kind of medical care institutions
Utilization of medical care institutions (korean·western medicine)
number of claims data
percentage(%)
number of sample patient
percentage(%)
korean medicine
44,277
68.81
3,325
40.46
western medicine
20,068
31.19
4,894
59.54
Utilization of medical care institutions
number of claims data
percentage(%)
number of sample patient
percentage(%)
korean medical hospital
1,928
3.00
309
3.76
korean medical clinic
42,349
65.82
3,016
36.70
western medical institutions
20,068
31.19
4,894
59.54
Table 11.
Burden of cost based on medical care institutions
(based on claims data)
korean medical institution
western medical institution
sum (unit : won)
burden of payer
743,191,430(54.79)
613,326,030(45.21)
1,356,517,460(100.00)
burden of patient
251,861,510(47.73)
275,764,260(52.27)
527,625,770(100.00)
sum of medical care expenses
995,143,690(52.61)
896,396,310(47.39)
1,891,540,000(100.00)
Table 12.
Claims data based on medical care institutions
western medicine claims data
korean medicine claims data
N
Mean
S.D.
Median
N
Mean
S.D.
Median
based on claims data
korean medical hospital
burden of payer
38
40,308
49,501
30,215
1,890
90,362
180,661
23,320
burden of patient
38
18,747
17,986
12,950
1,890
41,007
63,511
13,450
korean medical clinic
burden of payer
0
0
0
0
42,349
13,480
4,048
13,090
burden of patient
0
0
0
0
42,349
4,100
2,224
4,700
western medical institutions
burden of payer
19,879
30,231
163,283
9,120
189
65,445
124,896
30,470
burden of patient
19,879
13,618
54,046
3,100
189
26,696
49,213
10,730
based on patient
korean medical hospital
burden of payer
4
113,493
81,004
117,850
305
407,349
587,582
147,490
burden of patient
4
72,900
55,501
73,200
305
192,785
254,697
86,000
korean medical clinic
burden of payer
0
0
0
0
3,016
182,137
332,538
61,410
burden of patient
0
0
0
0
3,016
61,687
123,198
18,600
western medical institutions
burden of payer
4,837
137,398
423,736
22,510
57
314,094
390,596
168,210
burden of patient
4,837
57,036
159,192
9,200
57
115,835
138,575
71,600
* 정규분포를 하지 않는 자료이지만 질병부담 추정을 위해 mean과 median을 제시하였음
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