Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2021 Dec 1;16(12):e0260460. doi: 10.1371/journal.pone.0260460. eCollection 2021.
OBJECTIVE: The demand for treating degenerative lumbar spinal disease has been increasing, leading to increased utilization of medical resources. Thus, we need to understand how the budget of insurance is currently used. The objective of the present study is to overview the utilization of the National Health Insurance Service (NHIS) by providing the direct insured cost between patients receiving surgery and patients receiving nonsurgical treatment for degenerative lumbar disease. METHODS: The NHIS-National Sample Cohort was utilized to select patients with lumbar disc herniation, spinal stenosis, spondylolisthesis or spondylolysis. A matched cohort study design was used to show direct medical costs of surgery (n = 2,698) and nonsurgical (n = 2,698) cohorts. Non-surgical treatment included medication, physiotherapy, injection, and chiropractic. The monthly costs of the surgery cohort and nonsurgical cohort were presented at initial treatment, posttreatment 1, 3, 6, 9, and 12 months and yearly thereafter for 10 years. RESULTS: The characteristics and matching factors were well-balanced between the matched cohorts. Overall, surgery cohort spent $50.84/patient/month, while the nonsurgical cohort spent $29.34/patient/month (p<0.01). Initially, surgery treatment led to more charge to NHIS ($2,762) than nonsurgical treatment ($180.4) (p<0.01). Compared with the non-surgical cohort, the surgery cohort charged $33/month more for the first 3 months, charged less at 12 months, and charged approximately the same over the course of 10 years. CONCLUSION: Surgical treatment initially led to more government reimbursement than nonsurgical treatment, but the charges during follow-up period were not different. The results of the present study should be interpreted in light of the costs of medical services, indirect costs, societal cost, quality of life and societal willingness to pay in each country. The monetary figures are implied to be actual economic costs but those in the reimbursement system instead reflect reimbursement charges from the government.
目的：治疗退行性腰椎疾病的需求不断增加，导致医疗资源的利用增加。因此，我们需要了解保险预算的当前使用情况。本研究的目的是通过提供接受手术和非手术治疗退行性腰椎疾病的患者的直接保险费用，概述国民健康保险服务（NHIS）的利用情况。
方法：利用 NHIS-国家样本队列选择腰椎间盘突出症、椎管狭窄症、脊椎滑脱或脊椎裂患者。使用匹配队列研究设计，展示手术（n=2698）和非手术（n=2698）队列的直接医疗费用。非手术治疗包括药物治疗、物理治疗、注射和整脊治疗。在初始治疗、治疗后 1、3、6、9 和 12 个月以及此后每年的 10 年内，展示手术队列和非手术队列的每月费用。
结果：匹配队列之间的特征和匹配因素平衡良好。总体而言，手术队列的患者每月花费 50.84 美元，而非手术队列的患者每月花费 29.34 美元（p<0.01）。最初，手术治疗向 NHIS 收取的费用（2762 美元）高于非手术治疗（180.4 美元）（p<0.01）。与非手术队列相比，手术队列在头 3 个月每月多收费 33 美元，在 12 个月时收费较少，在 10 年内收费大致相同。
结论：手术治疗最初导致政府报销多于非手术治疗，但随访期间的费用没有差异。本研究的结果应根据每个国家的医疗服务成本、间接成本、社会成本、生活质量和社会支付意愿来解释。货币数字暗示实际经济成本，但报销系统中的数字反映了政府的报销费用。
Spine (Phila Pa 1976). 2014-10-15
N Engl J Med. 2007-5-31
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