Kwon Chan-Young, Park Il-Su
Department of Oriental Neuropsychiatry, Dong-Eui University College of Korean Medicine, Busan, Republic of Korea.
Department of Healthcare Management, College of Nursing, Healthcare Sciences and Human Ecology, Dong-Eui University, Busan, Republic of Korea.
J Pharmacopuncture. 2025 Mar 31;28(1):1-10. doi: 10.3831/KPI.2025.28.1.1.
This study aims to provide a practical framework for Korean medicine (KM) researchers on effectively utilizing Korean National Health Insurance (NHI) data, focusing on database characteristics, access methods, and methodological considerations for generating high-quality evidence in KM research.
This study analyzed the NHI data system structure, analyzing its two major databases the National Health Insurance Service (NHIS) and Health Insurance Review and Assessment Service (HIRA). We examined available data types, access protocols, and methodological approaches, with particular emphasis on their application in KM research. The study synthesized current challenges and opportunities specific to KM research using these databases.
Our analysis revealed three key findings 1) The distinct characteristics and complementary nature of NHIS and HIRA databases, with NHIS providing comprehensive longitudinal data suitable for cohort studies and HIRA offering detailed cross-sectional data optimal for utilization pattern analysis; 2) Multiple data access options including Sample Research DB and Customized Research DB from NHIS, and Patient Sample Data and Customized Research Data from HIRA, each with specific advantages for different research designs; 3) Critical methodological considerations for KM research, particularly addressing the limited coverage of KM services (0.8% of total covered items) and the high proportion of non-covered services in KM practices (24.2-49.2% across different institution types).
For effective utilization of NHI data in KM research, we recommend 1) Implementing hybrid research designs that combine health insurance data with institutional data to overcome limited KM coverage; 2) Establishing clear operational definitions and applying appropriate statistical methods for bias adjustment; 3) Working toward developing a specialized Korean Medicine Utilization Cohort Database. These approaches can enhance the quality and generalizability of KM research using health insurance data, ultimately contributing to evidence-based practice in Korean medicine.
本研究旨在为韩医学（KM）研究人员提供一个实用框架，以有效利用韩国国民健康保险（NHI）数据，重点关注数据库特征、获取方法以及在韩医学研究中生成高质量证据的方法学考量。
本研究分析了NHI数据系统结构，剖析了其两个主要数据库——国民健康保险服务（NHIS）和健康保险审查与评估服务（HIRA）。我们研究了可用的数据类型、获取协议和方法学途径，特别强调了它们在韩医学研究中的应用。本研究综合了使用这些数据库进行韩医学研究的当前挑战和机遇。
我们的分析揭示了三个关键发现：1）NHIS和HIRA数据库的不同特征和互补性质，NHIS提供适合队列研究的全面纵向数据，而HIRA提供适合利用模式分析的详细横断面数据；2）多种数据获取选项，包括NHIS的样本研究数据库和定制研究数据库，以及HIRA的患者样本数据和定制研究数据，每种选项在不同研究设计中都有特定优势；3）韩医学研究的关键方法学考量，特别是解决韩医学服务覆盖范围有限（占总覆盖项目的0.8%）以及韩医学实践中未覆盖服务比例较高（不同机构类型中为24.2 - 49.2%）的问题。
为了在韩医学研究中有效利用NHI数据，我们建议：1）实施将健康保险数据与机构数据相结合的混合研究设计，以克服韩医学覆盖范围有限的问题；2）建立明确的操作定义并应用适当的统计方法进行偏差调整；3）努力开发专门的韩医学利用队列数据库。这些方法可以提高使用健康保险数据进行韩医学研究的质量和可推广性，最终有助于韩医学循证实践。
