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Original Article
Others Background and Data Configuration Process of a Nationwide Population-Based Study Using the Korean National Health Insurance System
Sun Ok Song1,2, Chang Hee Jung3, Young Duk Song1, Cheol-Young Park4, Hyuk-Sang Kwon5, Bong Soo Cha2,6, Joong-Yeol Park3, Ki-Up Lee3, Kyung Soo Ko7, Byung-Wan Lee2,6
Diabetes & Metabolism Journal 2014;38(5):395-403.
DOI: https://doi.org/10.4093/dmj.2014.38.5.395
Published online: October 17, 2014
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1Division of Endocrinology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

2Department of Medicine, Yonsei University Graduate School of Medicine, Seoul, Korea.

3Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

4Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

5Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

6Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

7Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

corresp_icon Corresponding author: Byung-Wan Lee. Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. bwanlee@yuhs.ac
corresp_icon Corresponding author: Kyung Soo Ko. Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 139-707, Korea. kskomd@paik.ac.kr
*Sun Ok Song and Chang Hee Jung contributed equally to this study as first authors.
• Received: July 13, 2014   • Accepted: August 16, 2014

Copyright © 2014 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Background
    The National Health Insurance Service (NHIS) recently signed an agreement to provide limited open access to the databases within the Korean Diabetes Association for the benefit of Korean subjects with diabetes. Here, we present the history, structure, contents, and way to use data procurement in the Korean National Health Insurance (NHI) system for the benefit of Korean researchers.
  • Methods
    The NHIS in Korea is a single-payer program and is mandatory for all residents in Korea. The three main healthcare programs of the NHI, Medical Aid, and long-term care insurance (LTCI) provide 100% coverage for the Korean population. The NHIS in Korea has adopted a fee-for-service system to pay health providers. Researchers can obtain health information from the four databases of the insured that contain data on health insurance claims, health check-ups and LTCI.
  • Results
    Metabolic disease as chronic disease is increasing with aging society. NHIS data is based on mandatory, serial population data, so, this might show the time course of disease and predict some disease progress, and also be used in primary and secondary prevention of disease after data mining.
  • Conclusion
    The NHIS database represents the entire Korean population and can be used as a population-based database. The integrated information technology of the NHIS database makes it a world-leading population-based epidemiology and disease research platform.
History of the Korean Health Security system
Following the 'Medical Insurance Act' legislation in 1963, medical insurance societies for companies with more than 500 employees and insurance societies for public officials and private school employees were introduced in 1977. In addition to the expansion of coverage to smaller companies, universal coverage of the self-employed by medical insurance societies in rural and urban areas was implemented in 1988 and 1989, respectively. Based on the 'National Health Insurance Act' enacted in February 1999, all medical insurance societies were integrated into a single insurer in 2000. The single insurer was the National Health Insurance Corporation (NHIC). The single system was implemented to improve management efficiency and to achieve equity among insurance funds in relation to financial burden and other managerial issues [1,2,3]. In the same year, the separation of prescribing and dispensing drugs was also implemented. In 2008, the long-term care insurance (LTCI) system was introduced to alleviate the financial burden on unpaid family caregivers, helping elderly Koreans with difficulties performing the activities of daily living or housework due to geriatric diseases [4].
National Health Insurance system

National Health Insurance program

There are three main healthcare programs for universal coverage in Korea: National Health Insurance (NHI), Medical Aid (MA), and LTCI. The NHI program covers the whole population as a social insurance benefits scheme with the following features: it is compulsory and it provides short-term insurance; compulsory contributions are made according to ability to pay. The NHI program classifies individuals as either employees or self-employed. The MA program is managed by the Korean government. It is a public assistance scheme that secures the minimum livelihood of low-income households and assists with self-help by providing medical services [5]. The LTCI program is based on the principle of social solidarity. The program provides benefits for a period of at least 6 months.

NHI structure

There are three main regulators of the healthcare system in Korea: the Ministry of Health and Welfare (MOHW) and the National Health Insurance Service (NHIS), formerly NHIC (in 2013, NHIC changed its name into NHIS), and Health Insurance Review Agency (HIRA). MOHW supervises the NHI program through the formulation and implementation of policies. NHIS is a nonprofit organization and a single insurer that manages the NHI program. The NHI is responsible for managing enrolled and insured individuals and their dependents (spouse, direct lineal ascendants or descendants, and unmarried brothers or sisters), collecting of contributions and setting medical fee schedules. HIRA has a quality control role and evaluates healthcare performance and reviews medical billing and claims. HIRA also determines whether health care services are medically necessary and ensures that the services are delivered to beneficiaries at an appropriate level and cost [6]. Fig. 1 shows the "operational structure of the NHI program" [7].

Medical coverage of NHI

All Koreans residing in Korean territories are covered under one of the following three categories: employee insured, self-employed insured, and medical aid beneficiary [8,9]. Because the NHI program is mandatory for all Korean citizens, except for those with low incomes, health care providers cannot deny NHI patients and the enrollees are required to pay monthly contributions. The contribution to NHI is calculated based on an employee's wage and is paid by the company's employer. In the case of the self-employed, the cost is calculated based on the household income, property, income, vehicle(s) owned, age, and gender.

Types of insurance benefits

Although NHI covers the whole population as a compulsory scheme, not all items of healthcare are covered by the program. The aim is to cover the prevention and treatment of sickness and injury that result from daily life and childbirth. The program also covers health promotion and rehabilitation. NHI provides the same benefits package regardless of the contributions made, which are determined by the individual's ability to pay.
The benefits are granted both in-kind and in cash. The in-kind health benefits consist of health care benefits and check-ups. Health care benefits include diagnosis, tests, drugs, medical materials, treatment, surgery, preventive care, rehabilitation, hospitalization, nursing, and transportation provided by health care institutions in the treatment of disease, injuries, and so on. In the NHI program, the insured pay an average of 30% of the total medical costs related to almost all health care benefits. To discover and treat disease early and improve health, the NHI provides regular health check-ups and a cancer screening program. All insured Koreans who are at least 40 years old and their dependents can receive biannual health checks without cost. Under the cancer program, eligible people can receive examinations for the following specific cancers: cervical cancer for females aged 30 or older, stomach and breast cancer for those 40 or older, colon cancer for those 50 or older, and liver cancer for those aged 40 or older and considered a high-risk group for liver cancer based on the benefit details over the last 2 years. The individual is responsible for 10% of the cost.
There are two categories of items that do not have any coverage: (1) any medical services, drugs or materials provided or used for diseases that do not cause serious problems in daily life or work (simple snoring, fatigue, etc.); and (2) treatments that do not improve essential physical functions (e.g., plastic surgery, freckle removal, urogenic, and gynecological diseases that cause no problems in everyday life, treatment for narcotic addiction, orthodontics, etc.) [7,10]. In terms of financial coverage, copayments are applied for all medical procedures depending on the level of medical care received and whether the procedure was inpatient or outpatient [7].

Reimbursement flow

As shown in Fig. 1, the insured, the healthcare providers and the regulators of the healthcare system, including MOHW, NHIS, and HIRA, collaborate to operate the Korean NHI system. By providing healthcare to the insured, the healthcare providers can submit healthcare costs to NHIS. The claim costs are determined according to a coding system of disease and each medical treatment service. The coding system of disease follows diagnostic codes as per the International Classification of Diseases, 9th to 10th revision, clinical modification, ICD-10-CM code [11]. The claim data are sent to HIRA, which reviews the claims for reimbursement [6]. Finally, NHIS redeems their expenses paid and pays for healthcare service costs by paying healthcare providers or healthcare institutions. Therefore, nationwide claim data are collected by this review process operated by HIRA and is known as 'health insurance claiming data.' The claimed costs are reimbursed through fee-for-service for all services and referral levels. The physician fee is calculated by multiplying a resource-based relative value score for each treatment by the unit price.

Healthcare delivery system

The aim of the healthcare delivery system is to utilize healthcare services efficiently and to prevent patients from clustering at tertiary care hospitals. In principle, patients can select any practitioner or any medical care institution. If a patient wants to receive medical care from a tertiary care hospital, the patient has to present a referral slip issued by a doctor who works for an institution other than a tertiary care center. Exceptions to these referral channels are emergency medical care, rehabilitation, childbirth, medical service for a hemophiliac, family medicine, and dental care.
Study population
The baseline study population is all insured Koreans residing in Korean territories. These people are divided into three categories: NHI program for employee and self-employed groups and medical aid beneficiaries. The MA program is managed by the Korean government and is a public assistance scheme to secure the minimum livelihood of low-income households and to assist with self-help by providing medical services. As shown in Table 1 [12], 100% of the Korean population is covered by the Korean NHI system. In 2013, the NHI system covered 97.2% (n=49,989,620) of the population and the MA system covered the remaining and 2.8% (n=1,458,871) of the population.
Sources for data procurement
Subjects were identified from either the NHIS or HIRA databases. The HIRA database contains medical claims data for the entire Korean population as a result of the NHI system.
Quality of NHIS database
As described earlier, NHIS is a nonprofit organization and a single insurer that is responsible for operating a health insurance program. The NHIS manages the enrollment of the insured and their dependents and the collection of contributions. Based on the law, the NHIS may also perform compulsory financial collections from the insured. The data collected for this operation is called 'qualification and contribution data'.
As described in the introduction, health care providers submit reports about the medical services performed to HIRA, which is equivalent to a quality control department that provides a review of the medical costs incurred. These 'health insurance claiming reports' from healthcare providers contain information on the diagnosis and status of outpatients and inpatients. Additionally, the reports contain information related to drugs, such as the name, dosage, prescription date and periods, and method of administration. The reports also contain information on the use of laboratory and imaging tests.
Protection of personal information
The NHIS and HIRA provide data without the individual identifier, in accordance with the Act on the Protection of Personal Information Maintained by Public Agencies. Thus, the database included an unidentifiable code representing each individual. There are data concerning patient age, gender, diagnosis, and lists of prescribed drugs.
Data assessment
We obtained information on patient demographics, medical utilization/transaction information, insurer's payment coverage, and patient's deduction from the following databases: responsibility of payment and contribution of the insured database, claim database, health check-up database, and long-term insurance database.
The responsibility of payment and contribution of the insured database includes the following information: personal identification number (which is not a social identification number), sex, age, types of qualification (employee health insurance, self-employed health insurance, or MA program), date of birth, date of death, region where the insured applied for the NHI program, and disability and its type (if present).
The claim database consists of four detailed categories, including general information on specification (20T), consultation statements (30T), diagnosis statements determined by the International Classification of Diseases 10th revision (ICD-10; 40T), and detailed statements about prescriptions (60T). Each data table is designated by the letters 20T, 30T, 40T, 60T which consist of unique number table delimiter and T is referred to "table". Payment specification (20T) describes the following information: personal identification, health and medical care institution, principal diagnosis, first additional diagnosis, days of medical care, date of medical care commencement, number of visiting days, insurer and deduction payment, and so on. The consultation statement (30T) provides detailed information on the medical examination and treatment such as medical care, in-hospital administration of medicine, procedures, surgery, and so on. The diagnosis statement (40T) includes principal diagnosis and up to nine additional diagnoses. The detailed statement of prescriptions (60T) for the outpatient is a specification of prescription claims including the following: name of drug, date filled, days of supply, quantity dispensed, and price of each drug (Table 2).
As described above, the NHI program provides the benefits of a periodic health check-up program and a cancer screening program. The health check-up program allows data to be collected for the health check-up database. Each examinee must complete a standard questionnaire in this health check-up program. Thus, we can collect information for each examinee regarding past medical history, current medications, and lifestyle habits, such as drinking, smoking, exercise, and diet. In addition, we can collect information on anthropometric measurements, such as height, weight, body mass index, and blood pressure. Furthermore, several basic laboratory tests are performed in this health check-up program, including the following: urinalysis, hemoglobin, fasting glucose, lipid parameters (total cholesterol, triglycerides, high density lipoprotein cholesterol and low density lipoprotein cholesterol), creatinine, liver enzymes, hepatitis virus status, and simple chest radiograph.
The data in the long-term insurance database includes information on the presence of geriatric diseases and the cognitive function of the beneficiaries. Table 3 summarizes the data characteristics according to the NHIS program.
By applying the assumption of a hierarchy of health care actors and functions to the 27-box matrix established by Wendt et al. [13], the number of plausible healthcare system types shrinks to 10 (Table 4, Fig. 2) and there are various insurance systems depending on each national circumstances (Table 4) [13,14]. The compulsory nature of the Korean NHI system (established in 1989) means that the system provides universal coverage. NHI is a single insurer that manages the NHI program. It was one of the earliest adaptive organizations to exercise leadership in information technology (IT) among public institutions by strengthening and converging with the latest IT. Universal coverage made the NHIS database the best national indicator of health issues and has easy annual updates. Although NHIC fulfilled its public roles by building an information system in health policies, it did not fully provide scientific research data through cooperation with academic societies. The Korean Diabetes Association (KDA) and its members now face a demand to continually acquire new knowledge and conduct research using the public large-scale information system. Recently, the NHIS signed an agreement to provide open access to the databases with KDA for the benefit of Korean subjects with diabetes at 9th June 2014 [15].
Based on the lessons learned through past experiences in analyzing the Korea National Health and Nutrition Examination Surveys by KDA and its members, we have attempted to present the history, structure, contents, and a way to use data procurement in the Korean NHI system. The goal is to improve our understanding of the NHI database that contains the payment responsibility and contribution of the insured database, claim database, health check-up database, and long-term insurance database. However, there are some limitations in the use of these databases. These data do not include uninsured events and only represent the services covered by the NHI. The data may not be consistent with actual diagnosis because it is basically made for claim purposes. The consumption of over-the-counter drugs without medical prescription also cannot be determined using these databases. Previous studies showed that approximately 28% of total healthcare expenditure occurred in the non-reimbursed field. Additionally, only approximately 70% of primary diagnosis codes concurred with medical records and clinical diagnosis made by different subjective diagnostic criteria [16,17]. For these reasons, NHIS data might not reflect the genuine utilization pattern and should be validated [18]. Metabolic disease is incurable chronic disease such as diabetes, hypertension, etc., which is life-long after onset and produces various complications. Also, these diseases are more common with aging and give us persistently serious physical, psychological, and socioeconomic burden. There has been growing problem in aging society like our country. The Japanese Ministry of Health, Labour and Welfare (MHLW) is the main institution that conducts several surveys and collects health-care data. The MHLW has conceptualized the implementation of the National Claims Database, which is tasked to evaluate the government's Medical Care Expenditure Regulation Plan starting from 2008 which has two main targets: the prevention of lifestyle diseases and the shortening of the hospital length of stay. Japanese MHLW is for use in policy planning and decision making. Korea also began to use these data partially. Previous studies on osteoporosis [19,20] and gastric ulcer [21] were reported with using NIHS claim database shared with HIRA's database. Identification of the target population was based not only on the diagnosis code but also on the disease-specific interventions received by the patients [18]. NHIS data is based on mandatory, serial population data, so, this might show the time course of disease and predict some disease progress, and also be used in primary and secondary prevention of disease after data mining. There are various assignments in the field of diabetes, following as: from prevalence/incidence, mortality rate and cause, type/amount/cost of drug usage, changing trend in treatment modality, to outcome evaluation of the treatment with delta changes in indicators such hospitalization, mortality, complications in diabetic patients, and so on.
In conclusion, the NHIS database represents the entire Korean population and can be used as a population-based database. The integrated IT of the NHIS database makes it a world-leading population-based epidemiology and disease research platform.
Acknowledgements
The authors would like to thank Ji-Hae Yoon (Department of Benefit Security, National Health Insurance Service, Seoul, Korea) for her help.

No potential conflict of interest relevant to this article was reported.

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Fig. 1
Operational structure of the National Health Insurance program.
dmj-38-395-g001.jpg
Fig. 2
Plausible healthcare system types.
dmj-38-395-g002.jpg
Table 1
100% health insurance coverage for the Korean population by the National Health Insurance Service
dmj-38-395-i001.jpg

Modified from National Health Insurance Service [12].

Table 2
Components of claiming data in the National Health Insurance Service
dmj-38-395-i002.jpg

20T, 20 table, consist of unique number delimiter; 30T, 30 table, consist of unique number delimiter; 40T, 40 table, consist of unique number delimiter; 60T, 60 table, consist of unique number delimiter.

Table 3
The data characteristics according to the National Health Insurance Service program
dmj-38-395-i003.jpg
Table 4
Dispersion of OECD healthcare system
dmj-38-395-i004.jpg

R, regulation; F, financing; P, provision; St, state; So, societal actors; Pr, private actors.

aIndicates plausible, bIndicates implausible, cIndicates empirically existent types, dIndicates missing types, eOnly relative majority in financing, fOnly relative majority in service provision, gUntil 2013.

Figure & Data

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      Jiwon Kim, Namki Hong, Jimi Choi, Ju Hyung Moon, Eui Hyun Kim, Jae Won Hong, Eun Jig Lee, Sin Gon Kim, Cheol Ryong Ku
      European Journal of Endocrinology.2023; 189(2): 225.     CrossRef
    • Proton pump inhibitor use and the risk of metachronous gastric cancer after H. pylori eradication in patients who underwent endoscopic resection for gastric neoplasms: A population‐based cohort study
      Eun Jeong Gong, Hye‐Kyung Jung, Bora Lee, Jitaek Hong, Jong Wook Kim, Cheol Min Shin, Young Hoon Youn, Kwang Jae Lee
      Alimentary Pharmacology & Therapeutics.2023; 58(7): 668.     CrossRef
    • National Trends in Rotavirus Enteritis among Infants in South Korea, 2010–2021: A Nationwide Cohort
      Hyun Jee Lee, Yujin Choi, Jaeyu Park, Yong-Sung Choi, Dong Keon Yon, Do Hyun Kim
      Children.2023; 10(9): 1436.     CrossRef
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      Yong Kang Lee, Hyun Sun Lim, Youn I Choi, Eun Ju Choe, Seonji Kim, Seng Chan You, Kyung Joo Lee, Yerim Kim, Da Hee Park, Woon Geon Shin, Seung In Seo
      Pharmaceuticals.2023; 16(9): 1213.     CrossRef
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      Jae Young Kim, Changhwan Seo, Haeyong Pak, Hyunsun Lim, Tae Ik Chang
      Journal of Korean Medical Science.2023;[Epub]     CrossRef
    • Occupational characteristics and risk factors associated with endometriosis among Korean female workers
      Seunghyun Lee, Seung-Yeon Lee, Wanhyung Lee, Federico Romano
      PLOS ONE.2023; 18(10): e0292362.     CrossRef
    • Suicidal Thinking Among Patients With Spinal Conditions in South Korea: A Population-Based Cross-Sectional Study
      Tak Kyu Oh, Hye Yoon Park, In-Ae Song
      Psychiatry Investigation.2023; 20(9): 834.     CrossRef
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      Ho-Young Yhim, Juhyun Lee, Kyoung Ha Kim, Sang-A Kim, Ji Yun Lee, Hun-Gyu Hwang, Junshik Hong, Jeong-Ok Lee, Soo-Mee Bang
      Thrombosis Research.2023; 231: 50.     CrossRef
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      Jae-Woo Ju, Ho-Jin Lee, Karam Nam, Seungwook Kim, Hyunsook Hong, Seung Ho Yoo, Seohee Lee, Youn Joung Cho, Yunseok Jeon
      Anesthesia & Analgesia.2023;[Epub]     CrossRef
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      Ga Hee Kim, Hyungchul Park, Kee Wook Jung, Min-Ju Kim, Ye-Jee Kim, Ji Min Lee, Bong Eun Lee, Yang Won Min, Jeong Hwan Kim, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Hyun Jin Kim
      Gut and Liver.2023; 17(6): 894.     CrossRef
    • Differential Impact of Obesity on the Risk of Diabetes Development in Two Age Groups: Analysis from the National Health Screening Program
      Tae Kyung Yoo, Kyung-Do Han, Yang-Hyun Kim, Ga Eun Nam, Sang Hyun Park, Eun-Jung Rhee, Won-Young Lee
      Diabetes & Metabolism Journal.2023; 47(6): 846.     CrossRef
    • Association between preoperative modifiable lifestyle factors and mortality after cancer surgery: a population-based cohort study in South Korea
      Tak Kyu Oh, In-Ae Song
      Annals of Surgical Treatment and Research.2023; 105(4): 179.     CrossRef
    • Classification of long-term clinical course of Parkinson’s disease using clustering algorithms on social support registry database
      Dougho Park, Su Yun Lee, Jong Hun Kim, Hyoung Seop Kim
      Journal of Big Data.2023;[Epub]     CrossRef
    • Association between Proteinuria Status and Risk of Hypertension: A Nationwide Population-Based Cohort Study
      Hyungwoo Lee, Moo-Suk Park, Min Kyoung Kang, Tae-Jin Song
      Journal of Personalized Medicine.2023; 13(9): 1414.     CrossRef
    • Association of physical activity with the risk of Parkinson's disease in depressive disorder: A nationwide longitudinal cohort study
      Ji hyun An, Kyung-do Han, Jin-Hyung Jung, Hong Jin Jeon
      Journal of Psychiatric Research.2023; 167: 93.     CrossRef
    • Effect of changes in the hearing aid subsidy on the prevalence of hearing loss in South Korea
      Chul Young Yoon, Junhun Lee, Tae Hoon Kong, Young Joon Seo
      Frontiers in Neurology.2023;[Epub]     CrossRef
    • Preoperative Body Mass Index, Waist Circumference, and Mortality After Major Cancer Surgery: A Nationwide Cohort Study in Korea
      Tak Kyu Oh, In-Ae Song
      Journal of Korean Medical Science.2023;[Epub]     CrossRef
    • Characteristics and risk factors of suicide among people who attempted self-harm in South Korea: A longitudinal National Cohort Study in South Korea
      Hye Hyeon Kim, Jin Hyuk Lee, In Han Song, Yu Rang Park
      Psychiatry Research.2023; 330: 115613.     CrossRef
    • Association Between Premature Menopause and Cardiovascular Diseases and All‐Cause Mortality in Korean Women
      Gyu Bae Lee, Ga Eun Nam, Wonsock Kim, Byoungduck Han, Kyung Hwan Cho, Seon Mee Kim, Youn Seon Choi, Do Hoon Kim, Yong‐Gyu Park, Jin‐Hyung Jung, Kyungdo Han, Yang‐Hyun Kim
      Journal of the American Heart Association.2023;[Epub]     CrossRef
    • Risk of gastric cancer among long-term proton pump inhibitor users: a population-based cohort study
      Jong Wook Kim, Hye-Kyung Jung, Bora Lee, Cheol Min Shin, Eun Jeong Gong, Jitaek Hong, Young Hoon Youn, Kwang Jae Lee
      European Journal of Clinical Pharmacology.2023; 79(12): 1699.     CrossRef
    • Cancer Risk in Elderly Korean Patients with Neurodegenerative Disease and its relation to Type 2 Diabetes
      Hee-Cheol Kim, Ji-Hun Kim, Ho-Jun Lee, Yang-Tae Kim, Byeong-Churl Jang
      The Open Neurology Journal.2023;[Epub]     CrossRef
    • Performance of Cardiovascular Risk Prediction Models in Korean Patients With New‐Onset Rheumatoid Arthritis: National Cohort Study
      Jae Hyun Kim, Gaeun Lee, Jinseub Hwang, Ji‐Won Kim, Jin‐Won Kwon, Yun‐Kyoung Song
      Journal of the American Heart Association.2023;[Epub]     CrossRef
    • Impact of Propofol-based Total Intravenous Anesthesia Versus Inhalation Anesthesia on Long-term Survival After Cancer Surgery in a Nationwide Cohort
      Susie Yoon, Sun-Young Jung, Myo-Song Kim, Danbi Yoon, Younghae Cho, Yunseok Jeon
      Annals of Surgery.2023; 278(6): 1024.     CrossRef
    • Decreased Risk of Knee Osteoarthritis with Taller Height in an East Asian Population: A Nationwide Cohort Study
      Dong Hwan Lee, Hwa Sung Lee, Soo Hyun Jang, Jun-Young Heu, Kyungdo Han, Se-Won Lee
      Journal of Clinical Medicine.2023; 13(1): 92.     CrossRef
    • Cost-effectiveness of the anti-vascular endothelial growth factor intravitreal injection and panretinal photocoagulation for patients with proliferative diabetic retinopathy in South Korea
      Hyeon-Jeong Lee, Songhee Cho, Jungeun Park, Yan Jin, Hyung Min Kim, Donghyun Jee
      BMC Health Services Research.2023;[Epub]     CrossRef
    • Prior Evaluation of Nutritional Status and Mortality in Patients with Sepsis in South Korea
      Tak Kyu Oh, In-Ae Song
      Nutrients.2023; 15(24): 5040.     CrossRef
    • Increased Risk of Hip Fracture in Patients with Acromegaly: A Nationwide Cohort Study in Korea
      Jiwon Kim, Namki Hong, Jimi Choi, Ju Hyung Moon, Eui Hyun Kim, Eun Jig Lee, Sin Gon Kim, Cheol Ryong Ku
      Endocrinology and Metabolism.2023; 38(6): 690.     CrossRef
    • Cancer risks in patients with ankylosing spondylitis and the effects of biologic agents: a population-based study
      Sang-Yong Eom, Hyun-a Jang, Yo Han Im, Kyung-Hwa Choi, Ji Hyoun Kim
      Rheumatology.2023;[Epub]     CrossRef
    • Real-World Impact of Modern Reperfusion Therapy for Acute Ischemic Stroke : A Nationwide Population-Based Data Study in Korea
      Yung Ki Park, Byul-Hee Yoon, Yu Deok Won, Jae Hoon Kim, Hee In Kang
      Journal of Korean Neurosurgical Society.2023;[Epub]     CrossRef
    • Proton Pump Inhibitor Co-Therapy in Patients with Atrial Fibrillation Treated with Oral Anticoagulants and a Prior History of Upper Gastrointestinal Tract Bleeding
      So-Ryoung Lee, Soonil Kwon, Eue-Keun Choi, Jin-Hyung Jung, Kyung-Do Han, Seil Oh, Gregory Y. H. Lip
      Cardiovascular Drugs and Therapy.2022; 36(4): 679.     CrossRef
    • Institutional case volume-incorporated mortality risk prediction model for cardiac surgery
      Seohee Lee, Eun Jin Jang, Junwoo Jo, Dongnyeok Park, Ho Geol Ryu
      Asian Journal of Surgery.2022; 45(1): 189.     CrossRef
    • Does Surgical Ablation of Atrial Fibrillation Benefit Patients Undergoing Bioprosthetic Valve Replacement?
      Won Kyung Pyo, Ho Jin Kim, Joon Bum Kim, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee
      Seminars in Thoracic and Cardiovascular Surgery.2022; 34(3): 906.     CrossRef
    • Burden of comorbidities and medication use in childbearing women with rheumatic diseases: a nationwide population-based study
      Min Kyung Chung, Chan Hee Lee, Jin Su Park, Hyunsun Lim, Jisoo Lee
      The Korean Journal of Internal Medicine.2022; 37(6): 1250.     CrossRef
    • Validation of Dynamic Aspartate‐to–Alanine Aminotransferase Ratio for Predicting Liver Disease Mortality
      In‐Ae Song, Eun Sun Jang, Tak Kyu Oh
      Hepatology Communications.2022; 6(4): 740.     CrossRef
    • Blood Pressure Levels and Risks of Dementia: a Nationwide Study of 4.5 Million People
      Chan Joo Lee, Ji-Yeon Lee, Kyungdo Han, Da Hye Kim, Hanna Cho, Kwang Joon Kim, Eun Seok Kang, Bong-Soo Cha, Yong-ho Lee, Sungha Park
      Hypertension.2022; 79(1): 218.     CrossRef
    • Continuing regular physical activity and maintaining body weight have a synergistic interaction in improving survival: a population-based cohort study including 6.5 million people
      Chang-Hoon Lee, Kyung-Do Han, Da Hye Kim, Min-Sun Kwak
      European Journal of Preventive Cardiology.2022; 29(3): 547.     CrossRef
    • Liver enzymes and risk of ocular motor cranial nerve palsy: a nationwide population-based study
      Joonhyoung Kim, Kyungdo Han, Juhwan Yoo, Kyung-Ah Park, Sei Yeul Oh
      Neurological Sciences.2022; 43(5): 3395.     CrossRef
    • Underutilisation of prophylactic G-CSF in breast cancer patients receiving adjuvant docetaxel/cyclophosphamide chemotherapy
      Minhee Ku, Nam Kyung Je
      Journal of Chemotherapy.2022; 34(8): 534.     CrossRef
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      Bum Sik Tae, Young Eun Yoon, Woong Na, Kyung Jin Oh, Sung Yul Park, Jae Young Park, Hong Sang Moon
      Investigative and Clinical Urology.2022; 63(1): 92.     CrossRef
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      Sangmo Hong, Kyung-Soo Kim, Kyungdo Han, Cheol-Young Park
      European Heart Journal.2022; 43(15): 1491.     CrossRef
    • Pericardial Versus Porcine Valves for Surgical Aortic Valve Replacement
      Hong Ju Shin, Wan Kee Kim, Jin Kyoung Kim, Joon Bum Kim, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee
      Korean Circulation Journal.2022; 52(2): 136.     CrossRef
    • Effect of obesity and metabolic health on urolithiasis: A nationwide population-based study
      Changil Choi, Jong Keun Kim, Kyungdo Han, Young Goo Lee, Jun Hyun Han
      Investigative and Clinical Urology.2022; 63(1): 63.     CrossRef
    • Comprehensive risk assessment for hospital-acquired pneumonia: sociodemographic, clinical, and hospital environmental factors associated with the incidence of hospital-acquired pneumonia
      Bo-Guen Kim, Minwoong Kang, Jihyun Lim, Jin Lee, Danbee Kang, Minjung Kim, Jinhee Kim, Hyejeong Park, Kyung Hoon Min, Juhee Cho, Kyeongman Jeon
      BMC Pulmonary Medicine.2022;[Epub]     CrossRef
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      Jeonghoon Ha, See Hyun Park, Sung-Soo Park, Seunghoon Han
      The Journal of Clinical Endocrinology & Metabolism.2022; 107(4): 943.     CrossRef
    • Development of eClaim system for private indemnity health insurance in South Korea: Compatibility and interoperability
      Sungchul Bae, Byoung-Kee Yi
      Health Informatics Journal.2022;[Epub]     CrossRef
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      Yoonjeong Choi, Eun Young Kim, Jiyu Sun, Han-Kyoul Kim, Ye Seol Lee, Byung-Mo Oh, Hye Yoon Park, Ja-Ho Leigh
      Journal of Neurotrauma.2022; 39(5-6): 390.     CrossRef
    • Female Reproductive Factors and the Risk of Bronchiectasis: A Nationwide Population-Based Longitudinal Study
      Bumhee Yang, Dong-Hwa Lee, Kyungdo Han, Hayoung Choi, Hyung Koo Kang, Dong Wook Shin, Hyun Lee
      Biomedicines.2022; 10(2): 303.     CrossRef
    • Clinical outcomes of early closure versus conservative strategy after diagnosis with atrial septal defect: a nationwide population-based cohort study
      Sun-Yang Min, Ji Sung Lee, Duk-Woo Park, Jong-Min Song
      European Journal of Cardio-Thoracic Surgery.2022;[Epub]     CrossRef
    • Risk of Osteoporotic Fractures Among Obese Women Based on Body Mass Index and Waist Circumference: A Nationwide Cohort in South Korea
      Gyeongsil Lee, Seulggie Choi, Yoosun Cho, Sang Min Park
      Clinical Nutrition Research.2022; 11(1): 32.     CrossRef
    • Long-term prognosis and causes of death among survivors after out-of-hospital cardiac arrest: A population-based longitudinal study
      Yongil Cho, Jaehoon Oh, Jeong-Hun Shin, Byung Sik Kim, Jin-Kyu Park, Jun Ho Lee, Jae Hwan Kim, Minae Park
      Resuscitation.2022; 173: 31.     CrossRef
    • Blood pressure and mortality after percutaneous coronary intervention: a population-based cohort study
      Chung-woo Lee, Joo Kyung Lee, Yeon Joo Choi, Hyunjin Kim, Kyungdo Han, Jin-hyung Jung, Do Hoon Kim, Joo-Hyun Park
      Scientific Reports.2022;[Epub]     CrossRef
    • Analysis of Severe Hypoglycemia Among Adults With Type 2 Diabetes and Nonalcoholic Fatty Liver Disease
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      JAMA Network Open.2022; 5(2): e220262.     CrossRef
    • Hip Fracture Risk According to Diabetic Kidney Disease Phenotype in a Korean Population
      Seung Eun Lee, Juhwan Yoo, Kyoung-Ah Kim, Kyungdo Han, Han Seok Choi
      Endocrinology and Metabolism.2022; 37(1): 148.     CrossRef
    • Non-Alcoholic Fatty Liver Disease Defined by Fatty Liver Index and Incidence of Heart Failure in the Korean Population: A Nationwide Cohort Study
      Byoungduck Han, Gyu Bae Lee, Sun Young Yim, Kyung-Hwan Cho, Koh Eun Shin, Jung-Hwan Kim, Yong-Gyu Park, Kyung-Do Han, Yang-Hyun Kim
      Diagnostics.2022; 12(3): 663.     CrossRef
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      Eun Jee Park, Nam Ju Ji, Weon Young Lee
      Journal of Psychiatric Research.2022; 149: 226.     CrossRef
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      Sung Kyun Kim, Seok Jin Hong, Dae Myoung Yoo, Chanyang Min, Hyo Geun Choi
      Scientific Reports.2022;[Epub]     CrossRef
    • Prognosis of pregnancy after breast cancer diagnosis according to the type of treatment: A population-based study in Korea by the SMARTSHIP group
      Soo Youn Bae, Jihyoun Lee, Ji Sung Lee, Jae Sun Yoon, Ku Sang Kim, Yoo Seok Kim, Zisun Kim, Jun Won Min, Eun-Jung Shim, Ilkyun Lee, Min Hyuk Lee, Sungmin Park
      The Breast.2022; 63: 46.     CrossRef
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      Tae-lim Kim, Seong Jun Byun, Min Yong Seong, Byung-Mo Oh, Sang Jun Park, Han Gil Seo
      Journal of Bone and Mineral Metabolism.2022; 40(4): 602.     CrossRef
    • Risk prediction models incorporating institutional case volume for mortality after hip fracture surgery in the elderly
      Seokha Yoo, Eun Jin Jang, Junwoo Jo, Hannah Lee, Yoonbin Hwang, Ho Geol Ryu
      Archives of Orthopaedic and Trauma Surgery.2022; 143(5): 2307.     CrossRef
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      Seung Hoon Kim, Yong-Moon Park, Kyungdo Han, Seung Hyun Ko, Shin Young Kim, So Hyang Song, Chi Hong Kim, Kyu Yeon Hur, Sung Kyoung Kim, Juan F. Orueta
      PLOS ONE.2022; 17(4): e0266262.     CrossRef
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      Young Bae Choi, Keon Hee Yoo
      Cancer Research and Treatment.2022; 54(2): 572.     CrossRef
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      Eun Jung Park, Hye Jung Shin, Sung Soo Kim, Ki Eun Kim, Sun Hyun Kim, Youl Ri Kim, Kyong Mee Chung, Kyung Do Han
      International Journal of Environmental Research and Public Health.2022; 19(9): 4949.     CrossRef
    • Prolonged or Transition to Metabolically Unhealthy Status, Regardless of Obesity Status, Is Associated with Higher Risk of Cardiovascular Disease Incidence and Mortality in Koreans
      Juhee Lee, So-Young Kwak, Dahyun Park, Ga-Eun Kim, Clara Yongjoo Park, Min-Jeong Shin
      Nutrients.2022; 14(8): 1644.     CrossRef
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      British Journal of Cancer.2022; 127(3): 549.     CrossRef
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      Journal of the American Heart Association.2022;[Epub]     CrossRef
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      Bumhee Yang, Kyungdo Han, Bongseong Kim, Hyung Koo Kang, Jung Soo Kim, Eung-Gook Kim, Hayoung Choi, Hyun Lee
      Journal of Personalized Medicine.2022; 12(5): 691.     CrossRef
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      Byungyoon Yun, Sang Hoon Ahn, Jin-Ha Yoon, Beom Kyung Kim
      American Journal of Gastroenterology.2022; 117(5): 758.     CrossRef
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      Clinical Psychopharmacology and Neuroscience.2022; 20(2): 320.     CrossRef
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      Journal of Clinical Oncology.2022; 40(29): 3394.     CrossRef
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      International Archives of Occupational and Environmental Health.2022; 95(9): 1829.     CrossRef
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      Journal of Lipid and Atherosclerosis.2022; 11(2): 178.     CrossRef
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      Frontiers in Neurology.2022;[Epub]     CrossRef
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      Cancers.2022; 14(11): 2604.     CrossRef
    • Association Between Hypertension and Incident Infective Endocarditis
      Gyu Bae Lee, Koh Eun Shin, Kyungdo Han, Ho-Sung Son, Jae-Seung Jung, Yang-Hyun Kim, Hee-Jung Kim
      Hypertension.2022; 79(7): 1466.     CrossRef
    • Risk of secondary nonhematologic malignancies after allogeneic stem cell transplantation: A nationwide case‐control cohort study
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      International Journal of Cancer.2022; 151(7): 1024.     CrossRef
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      Eun Bin Cho, Yohwan Yeo, Jin-Hyung Jung, Su-Min Jeong, Kyungdo Han, Jeong Hoon Yang, Dong Wook Shin, Ju-Hong Min
      Multiple Sclerosis Journal.2022; 28(12): 1849.     CrossRef
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      Scientific Reports.2022;[Epub]     CrossRef
    • Association between migraine and risk of ocular motor cranial nerve palsy
      Soolienah Rhiu, Kyungdo Han, Juhwan Yoo, Kyung-Ah Park, Sei Yeul Oh
      Scientific Reports.2022;[Epub]     CrossRef
    • Statin use and risk of progression to liver cirrhosis in chronic hepatitis B independent of conventional risk factors: A nationwide study
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      Hepatology Communications.2022; 6(9): 2455.     CrossRef
    • Association Between Metabolic Syndrome and the Risk of Colorectal Cancer Diagnosed Before Age 50 Years According to Tumor Location
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      Gastroenterology.2022; 163(3): 637.     CrossRef
    • A positive faecal immunochemical test result and its association with the incidence of rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis: an analysis of one-million national colorectal cancer screening programme results
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      BMC Medicine.2022;[Epub]     CrossRef
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      Journal of Obesity & Metabolic Syndrome.2022; 31(2): 169.     CrossRef
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      Gut and Liver.2022; 16(4): 555.     CrossRef
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      Kihyun Lee, Sung-Soo Oh, Kyoung Sook Jeong, Yeon-Soon Ahn, Sei Jin Chang, Se Hwa Hong, Dae Ryong Kang, Sung-Kyung Kim, Sang-Baek Koh
      Yonsei Medical Journal.2022; 63(8): 774.     CrossRef
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      Yeong Ho Kim, Hyun Jee Kim, Jin Woo Park, Kyung Do Han, Yong Gyu Park, Young Bok Lee, Ji Hyun Lee
      Scientific Reports.2022;[Epub]     CrossRef
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      Hyun-Young Choi, Yongil Cho, Wonhee Kim, Yang-Ki Minn, Gu-Hyun Kang, Yong-Soo Jang, Yoonje Lee, Jae-Guk Kim, Jihoon Kim, Youngsuk Cho, Hyungoo Shin, Shinje Moon, Chiwon Ahn, Juncheol Lee, Dong-Geum Shin, Jae-Keun Park
      Journal of Personalized Medicine.2022; 12(8): 1260.     CrossRef
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      Journal of Cardiothoracic Surgery.2022;[Epub]     CrossRef
    • Effect of metabolic dysfunction‐associated fatty liver disease on liver cancer risk in a population with chronic hepatitis B virus infection: A nationwide study
      Byungyoon Yun, Sang Hoon Ahn, Juyeon Oh, Jin‐Ha Yoon, Beom Kyung Kim
      Hepatology Research.2022; 52(12): 975.     CrossRef
    • Non–Cystic Fibrosis Bronchiectasis Increases the Risk of Lung Cancer Independent of Smoking Status
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      Annals of the American Thoracic Society.2022; 19(9): 1551.     CrossRef
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      Diabetes & Metabolism Journal.2022; 46(5): 701.     CrossRef
    • Editor's Choice – Effect of Physical Activity and Tobacco Use on Mortality and Morbidity in Patients with Peripheral Arterial Disease After Revascularisation: A Korean Nationwide Population Based Cohort Study
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      European Journal of Vascular and Endovascular Surgery.2022; 64(4): 417.     CrossRef
    • Augmented risk of ischemic stroke in hypertrophic cardiomyopathy patients without documented atrial fibrillation
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    • Time‐ and Dose‐Dependent Association of Statin Use With Risk of Clinically Relevant New‐Onset Diabetes Mellitus in Primary Prevention: A Nationwide Observational Cohort Study
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    • Association of Long-term Use of Low-Dose Aspirin as Chemoprevention With Risk of Lung Cancer
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    • Association between BMI and risk of severe hypoglycaemia in type 2 diabetes
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    • Risk of Incident Dementia According to Metabolic Health and Obesity Status in Late Life: A Population-Based Cohort Study
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    • Increased Risk of Osteoporotic Fracture in Postgastrectomy Gastric Cancer Survivors Compared With Matched Controls: A Nationwide Cohort Study in Korea
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      American Journal of Gastroenterology.2019; 114(11): 1735.     CrossRef
    • Metabolic syndrome is associated with an increased risk of psoriasis: A nationwide population-based study
      Ha-Na Kim, Kyungdo Han, Yong-Gyu Park, Ji Hyun Lee
      Metabolism.2019; 99: 19.     CrossRef
    • Association of Exposure to Diagnostic Low-Dose Ionizing Radiation With Risk of Cancer Among Youths in South Korea
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    • Long‐term clinical outcomes in patients with autoimmune hepatitis according to treatment response in Asian country
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    • Effectiveness and Safety of Direct Oral Anticoagulant for Secondary Prevention in Asians with Atrial Fibrillation
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    • Optimal Rivaroxaban Dose in Asian Patients With Atrial Fibrillation and Normal or Mildly Impaired Renal Function
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      Stroke.2019; 50(5): 1140.     CrossRef
    • Tobacco Smoking and Alcohol Consumption Are Related to Benign Parotid Tumor: A Nested Case-Control Study Using a National Health Screening Cohort
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    • Increased Risk of Diabetes in Inflammatory Bowel Disease Patients: A Nationwide Population-Based Study in Korea
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    • Changes in the Diagnostic Efficiency of Thyroid Fine-Needle Aspiration Biopsy during the Era of Increased Thyroid Cancer Screening in Korea
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    • Safety and Effectiveness of Contemporary P2Y 12 Inhibitors in an East Asian Population With Acute Coronary Syndrome: A Nationwide Population‐Based Cohort Study
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    • Direct Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation and Low Body Weight
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    • Trends in varicella and herpes zoster epidemiology before and after the implementation of universal one-dose varicella vaccination over one decade in South Korea, 2003–2015
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    • Obesity Fact Sheet in Korea, 2018: Data Focusing on Waist Circumference and Obesity-Related Comorbidities
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    • Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care
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    • Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and Valvular Heart Disease
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    • Relation between Baseline Height and New Diabetes Development: A Nationwide Population-Based Study
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    • The Risk of Myocardial Infarction and Ischemic Stroke According to Waist Circumference in 21,749,261 Korean Adults: A Nationwide Population-Based Study
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    • The risk of end-stage renal disease in systemic lupus erythematosus
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    • Antithrombotic Therapy in Patients With Atrial Fibrillation After Percutaneous Coronary Intervention During 2-Year Follow-Up, from a Nationwide Population Study
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    • Outcomes After Use of Standard- and Low-Dose Non–Vitamin K Oral Anticoagulants in Asian Patients With Atrial Fibrillation
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    • Association between Atrial Fibrillation, Myocardial Infarction, Heart Failure and Mortality in Patients with Nontuberculous Mycobacterial Infection: a nationwide population-based study
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    • Severe hypoglycemia and the risk of cardiovascular disease and mortality in type 2 diabetes: a nationwide population-based cohort study
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    • Nationwide Trends in Pancreatitis and Pancreatic Cancer Risk Among Patients With Newly Diagnosed Type 2 Diabetes Receiving Dipeptidyl Peptidase 4 Inhibitors
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    • Validation of diagnostic codes of major clinical outcomes in a National Health Insurance database
      Jiesuck Park, Soonil Kwon, Eue-Keun Choi, You-jung Choi, Euijae Lee, Wonseok Choe, So-Ryoung Lee, Myung-Jin Cha, Woo-Hyun Lim, Seil Oh
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    • Effect of Case Volume on Mortality After Pediatric Liver Transplantation in Korea
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    • Appropriate Amount of Regular Exercise Is Associated with a Reduced Mortality Risk
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    • The effect of continuity of care on the incidence of end-stage renal disease in patients with newly detected type 2 diabetic nephropathy: a retrospective cohort study
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      Background and Data Configuration Process of a Nationwide Population-Based Study Using the Korean National Health Insurance System
      Diabetes Metab J. 2014;38(5):395-403.   Published online October 17, 2014
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    Background and Data Configuration Process of a Nationwide Population-Based Study Using the Korean National Health Insurance System
    Image Image
    Fig. 1 Operational structure of the National Health Insurance program.
    Fig. 2 Plausible healthcare system types.
    Background and Data Configuration Process of a Nationwide Population-Based Study Using the Korean National Health Insurance System
    Table 1 100% health insurance coverage for the Korean population by the National Health Insurance Service

    Modified from National Health Insurance Service [12].

    Table 2 Components of claiming data in the National Health Insurance Service

    20T, 20 table, consist of unique number delimiter; 30T, 30 table, consist of unique number delimiter; 40T, 40 table, consist of unique number delimiter; 60T, 60 table, consist of unique number delimiter.

    Table 3 The data characteristics according to the National Health Insurance Service program

    Table 4 Dispersion of OECD healthcare system

    R, regulation; F, financing; P, provision; St, state; So, societal actors; Pr, private actors.

    aIndicates plausible, bIndicates implausible, cIndicates empirically existent types, dIndicates missing types, eOnly relative majority in financing, fOnly relative majority in service provision, gUntil 2013.

    Song SO, Jung CH, Song YD, Park CY, Kwon HS, Cha BS, Park JY, Lee KU, Ko KS, Lee BW. Background and Data Configuration Process of a Nationwide Population-Based Study Using the Korean National Health Insurance System. Diabetes Metab J. 2014;38(5):395-403.
    Received: Jul 13, 2014; Accepted: Aug 16, 2014
    DOI: https://doi.org/10.4093/dmj.2014.38.5.395.

    Diabetes Metab J : Diabetes & Metabolism Journal
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