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Jung, Jang, Kim, Park, Park, Nam, and Choi: Health Care Costs of Digestive Diseases in Korea
Original Article

Korean J Gastroenterol 2011;58(6):323-331.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.58.6.323

Health Care Costs of Digestive Diseases in Korea

Hye-kyung Jung, BoHyoung Jang1, Youn Hee Kim1, JooYeon Park1, Sun Young Park1, Mi-Hee Nam1, Myung-Gyu Choi1, 2

1Department of Internal Medicine, Ewha Womans University School of Medicine, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea

2Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea

Correspondence to: Hye-kyung Jung, Department of Internal Medicine, Ewha Womans University School of Medicine, 911-1 Mok-dong, Yangcheon-gu, Seoul 158-710, Korea. Tel: +82-2-2650-2874, Fax: +82-2-2655-2874, E-mail: junghk@ewha.ac.kr

Received 22 May 2011       Accepted 25 August 2011

Copyright © 2011 Korean Ophthalmological Society

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.

Abstract

Background/Aims

Gastrointestinal (GI) diseases impose a heavy economic burden. We aimed to provide the first report on the health care utilization and costs of GI diseases in Korea.

Methods

We collected the data from all insurance claims database of National Health Insurance Corporation in Korea and the cause of death database in 2007 of Korea National Statistical Office. We compiled information about all digestive disease as a primary diagnosis on clinic visits, hospitalization, and cause of death from these databases.

Results

Seventeen million people (35.6%) had a diagnosis of GI diseases during the year 2007. Among them, the proportion of patients with upper GI diseases was prevalent in 54.9% (9.5 million patients/year). The 1/4 patients in outpatients clinic had any one of gastroesophageal reflux disease, irritable bowel syndrome and constipation. Thirteen percent of the total direct cost in 2007 was attributed to all GI diseases, which was 3,649 billion won (0.4% of GDP). The patients with hospitalization occupied by 5% of all patients with GI diseases, however, attributed to 58.9% of GI-related direct costs. GI malignancy was the major cause of medical expenses in hospitalization. Stomach cancer continues to be the leading cause of GI-related death in Korea.

Conclusions

GI diseases causes a heavy socioeconomic burden with high morbidity of functional GI disorders in outpatients care and high mortality of GI malignancy in inpatient care. This report highlights the healthcare utilization burden of GI diseases for researchers and public health policy maker to create new directions of integrated researches and health care plan.

Keywords: Digestive system diseases, Cost of illness

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Fig. 1.
Direct cost (in percent) of digestive system diseases in 2007. The diseases of appendix are included into lower gastrointestinal diseases (see text for details). GI, gastrointestinal.
kjg-58-323f1.tif
Table 1.
International Classification of Diseases 10th Version of Digestive Diseases
All digestive diseases ICD-10 codes
Esophagus or stomach disorders K20-K31
   Gastroesophageal reflux disease K21
   Dyspepsia K30
   Peptic ulcer disease K25-K26
    Gastric ulcer K25
    Duodenal ulcer K26
   Gastritis K29
Intestinal disorders K35–67
   Inflammatory bowel disease K50–51　
    Crohn's disease K50
    Ulcerative colitis K51
   Gastroenteritis K52
   Irritable bowel syndrome K58
   Constipation K59
   Appendicitis or other K35–37
Liver disease K70–77
   Alcoholic liver disease K70
   All viral hepatitis B15-B19
    Chronic hepatitis B B181
    Acute hepatitis A B15
Pancreatobiliary K80–87
    Pancreatitis K85–86
    Gallstones K80–82
Hemorrhoid I84
Major digestive disease cancers C15-C26
    Gastric cancer C16
    Colorectal cancer C18-C21
    Liver or biliary cancer C22-C24
    Pancreatic cancer C25
    Esophagus cancer C15
Other K90–93

ICD-10, International Statistical Classification of Diseases and Related Health Problems 10th Version.

Table 2.
Health Care Usage for Selected Digestive Diseases
Digestive disease Patients (n) Prevalence a Visit days Treatment amount b Total medical cost Percent c
Esophagus/stomach 9,475,549 19.6 23,300,568 505,601,653 681,039,261 18.7
   GERD 1,739,996 3.6 4,650,332 110,653,975 149,297,849 4.1
   Dyspepsia 505,522 1.0 853,396 12,844,409 17,369,363 0.5
   Peptic ulcer disease 1,583,289 3.3 4,672,662 145,812,049 195,546,544 5.4
   Gastritis 4,821,268 9.9 10,766,636 185,100,989 250,048,003 6.9
Intestinal disease 4,947,387 10.2 11,110,538 506,600,913 673,587,756 18.5
   Irritable bowel syndrome 1,442,057 3.0 2,672,268 57,816,260 78,068,299 2.1
   Constipation 1,241,745 2.6 2,233,750 41,090,911 55,458,299 1.5
   Inflammatory bowel disease e 41,529 0.1 228,021 15,446,940 20,539,525 0.6
   Acute gastroenteritis 1,923,923 4.0 3,128,812 57,793,390 77,765,289 2.1
   Disease of appendix 147,281 0.3 863,215 138,517,990 182,290,296 5.0
Liver disease 1,710,078 3.5 5,849,556 335,462,177 448,168,866 12.3
   Viral hepatitis 421,717 0.9 1,804,389 103,773,131 139,561,629 3.8
Pancreatobiliary disease 173,350 0.4 1,070,311 184,920,220 243,741,217 6.7
Hemorrhoid 599,627 1.2 2,433,702 184,129,754 243,460,610 6.7
Cancer in digestive system 269,863 0.6 5,291,597 1,007,895,516 1,334,180,340 36.6
   Stomach 104,548 0.2 1,696,628 295,855,831 391,679,719 10.7
   Colon/rectum 89,689 0.2 1,656,395 315,419,579 417,797,312 11.4
   Liver 45,521 0.1 1,114,090 245,028,856 324,281,837 8.9
   Pancreas 9,317 0.0 290,258 54,512,141 72,128,072 2.0
   Bile duct 58,495 0.1 1,436,825 301,810,592 398,064,793 10.9
   Esophagus 5,874 0.0 179,540 33,765,810 44,664,103 1.2
   Small bowel 1,710 0.0 31,198 6,303,973 8,353,117 0.2
Others 72,866 0.2 194,665 18,797,255 24,710,985 0.7
Total 17,248,720 35.6 49,250,937 2,743,407,488 3,648,889,034 100.0

Cost is presented as thousand Korean won.

Data from the National Health Insurance Corporation, which included all insurance claims database in Korea (2007).

GERD, gastroesophageal reflux disease.

a Prevalence is defined as the proportion of patients per Korean population estimate of 2007.

b Treatment amount is defined the total cost, which the medical care institution expended for the patients covered by insurer and benefi-ciary. Drug prescription costs are excluded.

c The percent of medical cost of each disease among total medical cost of all digestive disease.

Table 3.
Health Care Cost of Outpatient Care for Digestive Diseases
Digestive disease Patients (n) Visit days Treatment amount a Total medical costs Medical costs per person
Esophagus or stomach disorders 9,430,613 22,436,760 425,570,776 575,873,851 61
   GERD 1,730,732 4,490,230 99,485,781 134,622,166 78
   Dyspepsia 504,962 846,193 12,552,138 16,985,302 34
   Peptic ulcer disease 1,565,543 4,272,475 100,734,793 136,312,304 87
   Gastritis 4,806,982 10,570,166 174,187,054 235,706,433 49
Intestinal disorders 4,860,615 9,373,024 201,524,252 272,698,581 56
   Inflammatory bowel disease 39,993 171,197 6,168,597 8,347,223 209
    Crohn's disease 　 13,928 56,574 　 2,694,333 3,645,918 262
    Ulcerative colitis 27,040 115,111 3,281,062 4,439,867 164
   Irritable bowel syndrome 1,436,318 2,605,336 53,534,357 72,441,619 50
   Disease of appendix 126,924 225,605 6,883,614 9,314,769 73
   Constipation 1,236,904 2,169,548 37,381,814 50,584,322 41
Liver disease 1,674,060 4,592,026 187,918,641 254,287,741 152
   Viral hepatitis 415,553 1,580,296 81,735,717 110,603,135 266
Pancreatobiliary disease 151,905 377,308 20,997,575 28,413,498 187
   Gallstone 111,134 266,557 12,098,002 18,270,769 164
Hemorrhoid 582,507 1,680,788 38,420,276 51,989,549 89
Cancer in digestive system 251,863 1,981,037 249,100,871 337,078,310 1,338
Other 57,351 108,055 4,052,442 5,483,683 85
Total b 17,015,915 40,548,998 1,127,584,832 1,525,825,213 −

Cost is presented as thousand Korean won.

Data from the National Health Insurance Corporation, which included all insurance claims database in Korea (2007).

GERD, gastroesophageal reflux disease.

a Drug prescription costs are excluded.

b Total is excluded the overlap in disease category.

Table 4.
Health Care Cost of Inpatient Care for Digestive Diseases
Digestive disease Patients (n) Visit days Treatment amount a Total medical costs Medical costs per person
Esophagus/stomach disorders 91,061 863,808 80,030,877 105,165,410 1,155
   GERD 16,985 160,102 11,168,195 14,675,683 864
   Dyspepsia 560 7,203 292,271 384,062 686
   Gastritis 23,689 196,470 10,913,935 59,234,240 605
   Peptic ulcer disease 37,917 400,187 45,077,256 14,341,571 1,562
Intestinal disorders 291,271 1,737,514 305,076,662 400,889,175 1,376
   Inflammatory bowel disease 4,119 56,824 9,278,342 12,192,303 2,960
    Crohn's disease 1,744 25,788 4,961,495 6,519,704 3,738
    Ulcerative colitis 2,410 31,036 4,316,847 5,672,598 2,354
   Irritable bowel syndrome 8,667 66,932 4,281,903 5,626,680 649
   Constipation 6,473 64,202 3,709,097 4,873,977 753
   Disease of appendix 100,797 637,610 131,634,376 172,975,527 1,716
Liver disease 80,014 1,257,530 147,543,536 193,881,125 4,254
   Viral hepatitis 18,311 224,093 22,037,414 28,958,493 1,581
Pancreatobiliary disease 63,284 692,203 163,864,394 215,327,719 3,403
   Pancreatitis 13,504 161,955 27,182,220 35,719,080 2,645
   Gallstone 48,369 496,857 129,883,603 170,674,905 3,529
Hemorrhoid 213,357 752,914 145,709,478 91,471,061 897
Cancer in digestive system 117,204 3,310,560 758,794,645 997,102,030 8,507
Other 10,422 85,594 14,400,021 19,227,302 1,815
Total b 866,785 8,700,123 1,615,651,568 2,123,063,821 −

Cost is presented as thousand Korean won.

Data from the National Health Insurance Corporation, which included all insurance claims database in Korea (2007).

GERD, gastroesophageal reflux disease.

a Drug prescription costs are excluded.

b Total is excluded the overlap in disease category.

Table 5.
Trends of Medical Costs for Irritable Bowel Syndrome
Year Classification Patients (n) Visit days Treatment amount Total medical costs
2005 Health care service 1,282,975 2,548,731 48,533,419 60,408,941
  Inpatients 7,136 52,634 2,695,561 3,749,042
  Outpatients 1,278,058 2,496,097 45,837,859 56,659,899
  Drug prescription 1,084,270 1,601,053 25,865,157 26,582,895
  Total − 4,149,784 74,398,576 86,991,836
2006 Health care service 1,356,783 2,638,063 54,227,136 71,042,088
  Inpatients 7,775 60,451 3,383,396 4,487,262
  Outpatients 1,356,491 2,595,646 51,144,599 66,855,685
  Drug prescription 773,903 1,080,977 18,801,707 19,068,668
  Total − 3,719,040 73,028,843 90,110,756
2007 Health care service 1,442,057 2,672,268 57,816,260 78,068,299
  Inpatients 8,667 66,932 4,281,903 5,626,680
  Outpatients 1,436,318 2,605,336 53,534,357 72,441,619
  Drug prescription 1,105,148 1,716,608 29,301,197 29,687,130
  Total − 4,388,876 87,117,457 107,755,428

Cost is presented as thousand Korean won.

The number of health care service includes the patient's number of inpatients and outpatients. Patients in outpatients and inpatients are not mutually exclusive.

Table 6.
Total Death and Mortality Rates for Selected Digestive Diseases
Cause of death Deaths (n) Mortality rate
   Stomach cancer (C16) 10,563 21.5
   Malignant neoplasm of liver and intrahepatic duct (C22) 11,144 22.7
   Liver disease (K70-K76) 7,314 14.9
   Colorectal/anal cancer (C18-C21) 6,650 13.5
   Pancreatic cancer (C25) 3,569 7.3
   Esophageal cancer (C15) 1,449 2.9
   Lip/oro-pharyngeal cancer (C00-C14) 949 1.9
   Viral hepatitis (B15-B19) 1,024 2.1
   Ulcers (gastric/duodenal/peptic) (K25-K27) 532 1.1
   Infectious diarrhea/gastroenteritis (A09) 119 0.2
   Other infectious intestinal disease (A01-A08) 99 0.2
Total deaths related with digestive disease 51,854 105.5
Total deaths 244,874 498.4

Mortality, per 100,000 person.

Death data from the Korea National Statistical Office (2007). Data based on underlying cause of death, classified in accordance with the

International Statistical Classification of Diseases and Related Health Problems 10th Version codes.

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