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JKM > Volume 36(3); 2015 > Article
Hong, Umh, Kim, and Kim: Medical costs for patients with Facial paralysis : Based on Health Big Data

Abstract

Objectives:

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.

Fig. 1.
Average cost of the claims data based on medical care institutions
jkm-36-3-98f1.tif
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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