Trends in Korean Medicine Utilization for Chronic Rhinosinusitis Using National Health Insurance Service Data (2012–2022)
Article information
Abstract
Objectives
Chronic rhinosinusitis (CRS) is often treated with Korean medicine (KM), but comprehensive utilization data is lacking. This study aimed to analyze the patterns of KM use for CRS using National Health Insurance Service data from 2012 to 2022.
Methods
We conducted a retrospective analysis of claims data for CRS patients (International Classification of Diseases code: J32) who visited KM institutions. We examined demographic characteristics, visiting patterns, medical costs, treatment modalities, and concurrent use of Western medicine.
Results
Of 138,647 patients (52.2% male, mean age 23.8 years), 41.8% were under 10 years old. Annual patient numbers ranged from 14,595–17,242 (2012–2019), decreasing sharply from 2020. Average costs increased 5% annually. Acupuncture was the most common treatment (661,455, 50.5%). The most frequently prescribed insured herbal medicine was Hyeonggaeyeongyo-tang (48,494, 48.5%). Notably, 87.0% (120,610 patients) concurrently received Western medical treatment, indicating a prevalent integrative approach in CRS management. 77.8% received their initial diagnosis at Western institutions.
Conclusion
This comprehensive analysis of KM utilization for CRS in Korea reveals significant patterns in patient demographics, treatment preferences, and integration with Western medicine. The high rate of concurrent KM and Western treatment highlights the integrative nature of CRS management in Korea, providing valuable insights for health policy and clinical practice.
Introduction
Chronic rhinosinusitis (CRS) is a common condition characterized by inflammation of the paranasal sinus mucosa, leading to symptoms such as nasal obstruction, postnasal drip, facial pain, and olfactory dysfunction1–3). CRS is termed “Biyeon (鼻淵)” in the Korean medicine, a condition involving turbid nasal discharge4).
The prevalence of CRS varies globally, with reported rates of approximately 12% in the United States, 8% in China, and 10.8% in Korea5–7). Despite conventional treatments including medication and functional endoscopic sinus surgery (FESS), some patients seek complementary approaches, including acupuncture and herbal medicine8,9).
Korean Medicine (KM) approaches CRS treatment from a holistic perspective, considering the balance of the body’s systems. Traditional treatments such as herbal medicine, acupuncture, and moxibustion are used to address not only local symptoms but also underlying imbalances. For instance, certain herbal formulas are believed to clear heat and resolve dampness, which in KM theory are often associated with sinus inflammation.
The use of traditional medicine for CRS is not limited to Korea. In Taiwan, a population-based study found that 29% of CRS patients used traditional Chinese medicine (TCM) therapies, and those who did were less likely to undergo FESS9). In Japan, herbal formulas such as Keigairengyoto (荊芥連翹湯) are used for rhinitis and sinusitis, and have been reported to be potentially beneficial in post-operative care following sinus surgery10).
In Korea, according to the “2022 Korean Medicine Utilization Survey”, respiratory diseases rank fourth among reasons for visiting KM institutions, with usage increasing in recent years11). The “2023 Herbal Medicine Consumption Survey” reported that 53.2% of prescribed herbal medicines were for respiratory diseases, the highest among all disease categories12).
However, comprehensive data on KM treatment patterns, costs, and concurrent use of Western medicine for CRS is lacking. Moreover, the impact of the COVID-19 pandemic on KM utilization for CRS remains unclear. This study aims to analyze trends in KM utilization for CRS patients using National Health Insurance Service (NHIS) data from 2012 to 2022. By examining visiting patterns, medical costs, treatment combinations, insured herbal medicine usage, and concurrent Western treatments, we seek to provide valuable insights for health policy decisions and clinical practice in the management of CRS.
Methods
1. Data Source
This study utilized a customized research database from the NHIS. The NHIS covers approximately 50 million Koreans and maintains comprehensive healthcare data, including qualifications, insurance premiums, medical records, health examination results, and long-term care insurance information13). The study protocol was reviewed and approved by the Institutional Review Board of the Korea Institute of Oriental Medicine (IRB No. I-2401/001-001). The requirement for informed consent was waived due to the retrospective nature of the study and the use of anonymized data.
2. Study Design and Population
We conducted a retrospective analysis of NHIS claims data for patients diagnosed with CRS (International Classification of Diseases (ICD) code: J32) who visited Korean medicine clinics or hospitals between January 1, 2012, and December 31, 2022. The study included patients of all ages with valid health insurance coverage. We excluded data from other healthcare institutions such as public health centers and general hospitals.
The diagnosis of CRS in this study was based on the ICD code J32, which includes chronic maxillary sinusitis (J32.0), chronic frontal sinusitis (J32.1), chronic ethmoidal sinusitis (J32.2), chronic sphenoidal sinusitis (J32.3), chronic pansinusitis (J32.4), other chronic sinusitis (J32.8), and chronic sinusitis, unspecified (J32.9).
Treatment modalities recorded in the NHIS data include acupuncture, moxibustion, cupping, hot and cold meridian therapy (hot pack, cold pack, and infrared therapy) and herbal medicine prescriptions. The specific points used for acupuncture and cupping are not captured in the insurance data.
3. Variables and Outcomes
We analyzed the following variables: 1. Demographic characteristics (age and sex) 2. Annual number of patients visiting KM institutions for CRS 3. Average medical costs per patient 4. Frequency of visits to KM clinics versus hospitals 5. Initial diagnosis institution (KM or Western medicine) 6. Concurrent use of Western medical treatments 7. KM treatment modalities and combinations 8. Frequency and types of insured herbal medicine prescriptions.
4. Statistical Analysis
Data handling and statistical analyses were performed using SAS 7.15 (SAS Institute Inc., Cary, NC, USA). Descriptive statistics were used to summarize patient characteristics and treatment patterns. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. We used Student’s t-test for continuous variables and chi-squared test for categorical variables, with a significance level of 0.05.
Results
1. Demographic Characteristics
A total of 138,647 patients with CRS visited Korean medicine institutions during the study period. The sample comprised 52.2% males and 47.8% females, with a mean age of 23.8 ± 22.0 years. The age distribution showed a notable prevalence of young patients, with 41.8% under 10 years old, followed by 13.2% in their 30s, 9.7% in their 40s, and 9.3% each in their 20s and teens (Table 1).
Demographic Characteristics of Study Participants
2. Patient Visits and Costs
The annual number of CRS patients visiting KM institutions ranged from 14,595 to 17,242 between 2012 and 2019. However, there was a sharp decline starting in 2020, with patient numbers dropping to 9,851 in 2020 and 6,683 in 2021, followed by a slight increase to 6,976 in 2022 (shown in Fig. 1).
Annual patients to Korean medicine institutions for chronic rhinosinusitis and rate per 100,000 population.
The average medical cost per patient increased steadily from 12.81 USD in 2012 to 21.10 USD in 2022, representing an annual growth rate of approximately 5%. The total annual treatment cost for CRS in KM institutions peaked at 1,338 thousand USD in 2019 before decreasing to 633 thousand USD in 2022 (Table 2).
Treatment Costs for Chronic Rhinosinusitis in Korean Medicine Institutions
Analysis of visits by age group revealed that patients under 10 years old accounted for the highest number of visits at 273,828, followed by those aged 10–19 years with 100,825 visits. Patients in their 40s, 30s, and 50s had similar visit frequencies of 66,250, 65,412, and 64,388 visits respectively (shown in Fig. 2).
Visits to Korean medicine institutions for chronic rhinosinusitis by age group
3. Healthcare Utilization Patterns
Among CRS patients, 77.8% received their initial diagnosis at Western medical institutions, while 22.2% were first diagnosed at KM institutions. The majority of patients (87.0%) utilized both KM and Western medical treatments concurrently (shown in Fig. 3-a). KM institutions usage showed a clear preference for clinics over hospitals, with 96.5% of visits occurring at KM clinics and only 3.5% at KM hospitals (shown in Fig. 3-b). Among 138,647 CRS patients who received Korean medicine treatment, 120,610 patients (87.0%) also received Western medical treatment concurrently (shown in Fig. 3-c).
First-contact healthcare institution, visits to Korean medicine institutions, and concurrent Western medical treatments for chronic rhinosinusitis
a. First medical institution visited for chronic rhinosinusitis
b. Chronic rhinosinusitis patients visiting Korean medicine clinics and hospitals
c. Chronic rhinosinusitis patients receiving both Korean and Western medicine treatments
4. Treatment Modalities and Combinations
The most commonly used treatment method for CRS was acupuncture (661,455, 50.5%), and the treatment combination was cupping-acupuncture (251,305, 37.2%). In addition to acupuncture and cupping, hot and cold meridian therapy and insured herbal extracts were used either individually or in combination (Table 3, 4).
Individual Treatment Modalities Used in Korean Medicine Institutions for Chronic Rhinosinusitis
Combination Treatment Modalities Used in Korean Medicine Institutions for Chronic Rhinosinusitis
5. Insured Herbal Medicine Usage
Insured herbal medicine was prescribed to 13.9% of CRS patients. The most frequently prescribed formula was Hyeonggaeyeongyo-tang (荊芥連翹湯, 48.5%), followed by Socheongryong-tang (小靑龍湯, 11.8%), Galgeun-tang (葛根湯, 5.9%), Yeonkyopaedok-san (連翹敗毒散, 4.4%), and Haengso-tang (杏蘇湯, 4.2%) (shown in Fig. 4).
Frequently prescribed herbal medicines for chronic rhinosinusitis
Discussion
This study provides the first comprehensive analysis of Korean medicine (KM) utilization trends for chronic rhinosinusitis (CRS) using NHIS data. Our findings offer valuable insights into the demographics of CRS patients seeking KM treatments, the impact of the COVID-19 pandemic on healthcare utilization, and the patterns of KM treatments for CRS.
The demographic profile of CRS patients in our study revealed a higher proportion of male patients (52.2%) and a notable prevalence among young children, with 41.8% of patients under 10 years old. In South Korea, among CRS patients receiving Western treatment, those under the age of 10 account for 19%14). Considering that patients who typically use KM tend to be older, the high number of pediatric CRS patients opting for traditional treatment is a noteworthy finding. The high prevalence of CRS in children seeking KM treatment may reflect parental preferences for non-invasive, holistic approaches to managing chronic conditions in pediatric populations15).
The sharp decline in patient numbers from 2020 onwards clearly demonstrates the impact of the COVID-19 pandemic on healthcare-seeking behaviors. This trend aligns with observations in Western medicine, where a decrease in visits for various otolaryngological conditions was reported during the pandemic16). The slight increase in patient numbers in 2022 may indicate a gradual return to pre-pandemic healthcare utilization patterns, though continued monitoring is necessary to confirm this trend.
Our analysis revealed that 77.8% of CRS patients received their initial diagnosis at Western medical institutions, with 87.0% utilizing both KM and Western treatments concurrently. The background of these results may involve various factors, but primarily, the lack of diagnostic equipment to evaluate CRS seems to be the most significant cause. Generally, CRS can be diagnosed when abnormal findings are observed in endoscopy, paranasal sinuses (PNS) X-ray, or computed tomography alongside symptoms; however, it is rare for KM institutions to possess such equipment17). As a result, patients view traditional medicine as a complementary rather than an alternative approach to CRS management. This also highlights the need for improved integration and communication between traditional and Western medicine practitioners to ensure optimal patient care.
The predominance of acupuncture reflects the central role of these modalities in KM approaches to CRS. However, the relatively low usage of insured herbal medicine contrasts with findings from Taiwan, where herbal medicine was more frequently prescribed than acupuncture for CRS9). This discrepancy may be due to differences in insurance coverage for herbal medicines between the two countries, as Korea’s national health insurance covers only 56 herbal formulas, compared to 337 in Taiwan9,18).
The relatively low usage of insured herbal medicine in our study may not reflect the full picture of herbal medicine use for CRS in Korea. A previous study reported that many KM doctors frequently use uninsured herbal extracts in their practice18). This suggests that the actual use of herbal medicine for CRS might be higher than what our data indicates.
Furthermore, the insurance coverage for herbal medicines varies significantly across East Asian countries. While Korea’s national health insurance covers 56 herbal formulas, Taiwan covers 337, and Japan has 147 prescriptions listed in their medical insurance price list19,20). This disparity in coverage might influence the treatment patterns and choices made by practitioners and patients.
Hyeonggaeyeongyo-tang (荊芥連翹湯) is the most frequently prescribed herbal formula for Chronic Rhinosinusitis (CRS), accounting for 48.5% of insured herbal prescriptions. This differs from the prescribing patterns for other upper respiratory conditions, such as common cold or allergic rhinitis, where Socheongryong-tang (小靑龍湯) is typically the most prescribed21,22). This distinction suggests that KM practitioners may emphasize different treatment principles for CRS compared to other respiratory conditions. The preference for Hyeonggaeyeongyo-tang in CRS treatment aligns with the traditional KM theory of clearing heat and resolving toxins.
The high proportion of pediatric patients in our study (41.8% under 10 years old) is particularly noteworthy. This could reflect a parental preference for non-pharmacological and traditional approaches in managing chronic conditions in children. Future research should explore the reasons behind this trend and evaluate the effectiveness and safety of KM treatments for pediatric CRS.
Limitations of this study include the reliance on insurance claim codes for CRS diagnosis, which may not capture the full clinical picture or severity of the condition. Additionally, our analysis does not include non-reimbursed treatments, which may play a significant role in KM management of CRS. Future studies incorporating clinical data and patient-reported outcomes would provide a more comprehensive understanding of KM’s role in CRS management.
Conclusion
By analyzing the visit patterns of CRS patients at Korean medicine institutions (Korean medicine clinics and hospitals) extracted from the customized research database of NHIS from 2012 to 2022, we reached the following conclusions.
The annual number of patients ranged from 14,595(28.5 per 100,000) to 17,242(33.2 per 100,000) in 2012–2019. However, starting in 2020, the number of patients sharply declined, followed by a slight increase to 6,976(13.5 per 100,000) in 2022. This suggests that the COVID-19 situation affected patient visits.
The average medical cost per patient increased from 16,658 KRW (12.81USD) in 2012 to 27,432KRW (21.10USD) in 2022, rising by approximately 5% each year.
Among CRS patients, 77.8% received their initial diagnosis at Western medical institutions, and 87.0% of patients utilized Western medical treatments concurrently. The usage of Korean medicine clinics was higher at 96.5% compared to Korean medicine hospitals.
Acupuncture was the most common treatment (50.5%). The most frequently prescribed insured herbal medicine was Hyeonggaeyeongyo-tang (荊芥連翹湯, 48.5%), followed by Socheongryong -tang (小靑龍湯, 11.8%), Galgeun-tang (葛根湯, 5.9%), Yeonkyopaedok-san (連翹敗毒散, 4.4%), and Haengso-tang (杏蘇湯, 4.2%).
Acknowledgments
This study was funded by the Korea Institute of Oriental Medicine (Grant No. KSN20233303, KSN2312022 and KSN1824130) and the Korea Health Industry Development Institute (Grant No. NHN2112170). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.