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An epidemic of cataract surgery in Korea: the effects of private health insurance on the National Health Insurance Service
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Hyejin Lee, Soo-Hee Hwang, Choon-Seon Park, Seol-Hee Chung, Catherine L. Chen, Jin Yong Lee, Jin Soo Lee
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Epidemiol Health. 2024;46:e2024015. Published online January 6, 2024
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DOI: https://doi.org/10.4178/epih.e2024015
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 Abstract
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Abstract
OBJECTIVES
In Korea, the National Health Insurance Service (NHIS) covers essential healthcare expenses, including cataract surgery. To address concerns that private health insurance (PHI) might have inflated the need for such procedures, we investigated the extent of the PHI-attributable increase in cataract surgery and its impact on NHIS-reimbursed expenses.
METHODS This retrospective, observational study uses nationwide claims data for cataract surgery from 2016 to 2020. We examined trends in utilization and cost, and we estimated the excess numbers of (1) cataract operations attributable to PHI and (2) types of intraocular lenses used for cataract surgery in 2020.
RESULTS Between 2016 and 2020, a 36.8% increase occurred in the number of cataract operations, with increases of 63.5% and 731.8% in the total healthcare costs reimbursed by NHIS and PHI, respectively. Over a 5-year period, the surgical rate per 100,000 people doubled for patients aged <65 years (from 328 in 2016 to 664 in 2020). Among the 619,771 cases in 2020 of cataract surgery reimbursed by the Korean diagnosis-related group system, more non-NHIS-covered intraocular lenses were used for patients aged <65 years than ≥65 years (68.1 vs. 14.2%). In 2020 alone, an estimated 129,311 excess operations occurred, accounting for an excess cost of US$115 million.
CONCLUSIONS A dramatic increase in the number and cost of cataract operations has occurred over the last 5 years. The PHI-related increase in operations resulted in increased costs to NHIS. Measures to curtail the non-indicated use of cataract surgery should be implemented regarding PHI.
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Summary
Korean summary
백내장 수술에서 실손보험으로 인한 의료비 증가 수준을 확인하고 건강보험급여 비용에 미치는 영향을 조사했을 때 2016년과 2020년 사이에 백내장 수술 건수는 36.8% 증가했으며, 건강보험과 실손보험에서 지급한 총 의료 비용은 각각 63.5%와 731.8% 증가했다. 백내장 수술은 65세 미만에서 주로 증가하였으며, 이 연령층은 공단에서 급여하지 않는 고가의 인공수정체를 더 많이 사용하였다. 추정 초과 수술 건수는 2020년에만 129,311건으로 1억 1,500만 달러의 초과 비용이 발생했다.
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