Introduction
Acupuncture and moxibustion medicine are representative areas of Korean medicine that aim to prevent and treat conditions/diseases by provoking reactions in the body using physical stimulation in certain areas, based on theories of traditional Korean medicine [
1]. Between 2005 and 2014, the main conditions/diseases which were treated in the Department of Acupuncture and Moxibustion Medicine, DaeJeon Korean medicine hospital, DaeJeon University were spinal, joint, and paralysis conditions/diseases which accounted for 21.2% of total patient population [
2].
It has been reported in 2006 and 2010 that there has been an increase in the number of patients visiting Korean medicine hospitals for the treatment of spine, joint, and paralysis conditions/diseases [
3,
4]. As of the 3
rd quarter of 2019, the medical expense’s statistics index of Health Insurance Review and Assessment Service and National Health Insurance Service, reported that the allowance of medical care paid to Korean medicine centers for spine, joint and paralysis conditions/diseases was about 578.6 billion Korean won, which was a 10.38% increase from about 524.2 billion Korean won in the 3
rd quarter of 2018 [
5]. An increasing interest of patients towards Korean medicine treatment of spine, joint, and paralysis conditions/diseases is apparent. Therefore, there is a need to analyze the patient demographics of those individuals who seek Korean medicine treatment. Previously, the change in the number of patients by year from 1980 to 2004 has been studied [
5], with one study on the number of facial palsy patients by year from 2004 to 2008 [
4], analysis of the sociodemographic characteristics and usage by year of hospitalized patients from 2004 to 2015 [
2], and analysis of the patient distribution of age, sex, month, systematic categorization of condition/disease, single condition/disease, and number of conditions/diseases for hospitalized patients from 2011 to 2012 [
6] has been published. However, there are currently no studies on the outpatients of the Department of Acupuncture and Moxibustion Medicine, only studies on a single condition/disease, and a lack of studies that comprehensively analyze the insurance types of categorization for a particular condition/disease. To address these criteria the medical records of patients who visited the Department of Acupuncture and Moxibustion Medicine of DaeJeon Korean medicine hospital, DaeJeon University from March 1, 2015 to February 29, 2020 were retrospectively analyzed.
Discussion
The demand for Korean medicine is expected to rise with the aging demographic of the population in Korea, and a change in the condition/disease structure of the insurance companies reported in 2012 [
6]. The allowance of medical care paid to Korean medicine hospitals in the 3
rd quarter of 2019 was approximately 314.5 billion Korean won, and the allowance of medical care paid to Korean medicine hospitals in the 3
rd quarter of 2018 was approximately 274.3 billion Korean won, showing an annual increase of 14.70% [
5]. Thus, as the demand for Korean medicine treatment increases, there is need for understanding the sociodemographic characteristics and patient use of Korean medicine institutions, to sharpen the competitiveness of Korean medicine hospitals. The patient demographic characteristics according to sex, age, type of insurance, and condition/disease of the patients who visited the Department of Acupuncture and Moxibustion Medicine, DaeJeon Korean medicine hospital, DaeJeon University from March 1, 2015 to February 29, 2020, was analyzed.
The number of first visit and repeat patients at the Department of Acupuncture and Moxibustion Medicine, DaeJeon Korean medicine hospital, DaeJeon University, in the last 5 years was 13,591. There were 5,423 (39.9%) male and 8,168 (60.1%) female patients. Every year the mean number of male patients increased by 449.0, and the mean number of female patients increased by 657.9 every year. Inquiring into the difference of health status between male and female patients and the difference of use of medical care, more female patients were determined to be in morbid state of chronic condition/disease and felt unhealthy, as well as experiencing limitations in activities in everyday life [
7]. On the use of medical services, as shown in previous studies [
7], more female patients visited outpatient clinics and used Korean medicine treatments. Whilst the number of both male and female patients increased, the annual rate of increase was higher in female patients and accounted for an increase of 657.9 patients per year compared with 449.0 male patients.
The most common age of all patients was those in the 50’s group, followed by 40’s, and 60’s. The number of middle-aged patients in their 40’s, 50’s, and 60’s combined was 8,663, which was 63.7% of the total number of patients who visited the hospital. The allowance spent on medical care in the 3
rd quarter of 2019 was the highest in the patients aged in their 60’s [
5], confirming that the major age group that visited the Korean medicine hospital in Daejeon was the same age group that takes up a large proportion of the national medical care. The life expectancy of Koreans is 82.1 years in 2019, which is on a sharp increase from 62.3 years in 1970, showing increase of 19.8 years in 33 years [
8]. In addition, according to an index calculated using a survey on health by the Organization for Economic Co-operation and Development, only 32.5% of Koreans answered they had “very good” or “good” health, which is less than half of the Organization for Economic Co-operation and Development average 68.2% [
8]. Due to the low level of subjective recognition of health status, the middle-aged population using medical services is steadily rising. It has been reported that the older the age, the higher the subjective expectation of receiving medical services provided by the government, and the satisfaction level is higher [
9]. The number of hospital visits by the middle-aged patients is thought to be of great importance. In most age groups the number of patients visiting hospitals is increasing, which shows that the general demand for Korean medicine treatment is on the rise, and the rate of increase of patients in their 50’s (285.6 patients per year) is the highest, followed by patients in their 60’s (232.4 patients per year), and 40’s (202.9 patients per year).
Among the 5,816 first visit patients 1,325 patients (22.8%) used automobile insurance which increased by 99.1 patients per year, and 4,491 patients (77.2%) used health insurance which increased by 395.0 patients per year. It was reported in 2019 that the number of patients receiving only Western medicine treatment is decreasing whilst the number of patients receiving only Korean medicine treatment is increasing, and the number of patients choosing Korean medicine institutions as the first medical service when using automobile insurance is on the rise [
10]. This shows that some of the patients who used Western medicine moved over to using Korean medicine, and that Korean medicine is sufficiently performing the role of an alternative to Western medicine. In addition, the increase of the number of patients using both Western medicine and Korean medicine indicates that patients who previously received only Western medicine treatment, are additionally receiving Korean medicine treatment, which concurs with the previous study [
10].
Among the patients who used health insurance, the number of patients with medical care was 166 (3.7%), showing a decrease in the number of patients in 2017, and a gradual increase since then. The number of patients using health insurance without medical care was 4,325 (96.3%), showing an increase of 386.1 patients per year. The ratio of patients using medical care was low but gradually increasing, and this is thought to be the result of the total number of patients in the near poverty group who receive Korean medicine treatment as a benefit by the state being small. However, it seems to be gradually increasing over the 5 years.
Conditions/diseases are classified as injury or sickness, and whether it is identified as injury depends on the presence of a reasonable cause-and-effect relationship. Other condition/diseases with past symptoms are categorized as sickness. Among the patients who visited the hospital for the first time, the number of patients with an injury was 2,415 (41.5%), and showed an increase of 196.7 patients per year. The number of patients who visited with sickness was 3,401 (58.5%), an increase of 297.4 patients per year. The main form of the existing medical service was the treatment of the condition/disease. In recent times, the development of technology, and diversity of careers may have created more possibilities of accidents, and the number of patients visiting hospitals with injuries is on the rise considerably, compared with the number of patients visiting with sicknesses [
11]. In this study, the result showed the number and rate of increase of patients with sicknesses was greater than those patients with injuries, but the number and the rate of increase of patients visiting with injuries was also on the rise. These results are thought to show the recognition of Korean medicine treatment has expanded to the treatment of injuries from simple convalescence, chronic condition/disease, and strength enhancement [
12].
In recent times, most patients who visit Korean medicine hospitals belong to condition/disease code M which is “condition/disease of musculoskeletal system and connective tissue,” and condition/disease codes S and T which are “other specific result of injury, intoxication, and external cause.” As shown in a previous study [
13] patients who visited local clinics to be treated using the M, S, or T codes consisted of 40% of the total patients. In the Department of Acupuncture and Moxibustion Medicine, DaeJeon Korean Medicine hospital, DaeJeon University, most patients visited with complaints including pain, joint illness, and paralysis. Among the illnesses 16 groups of frequently presented conditions/diseases were categorized, and the number of first visit patients belonging to the 16 groups was 5,061 (87.0%) out of a total of 5,816 patients.
Amongst the 16 groups of frequently presented conditions/diseases, there were 991 patients (17.0%) who were categorized into the sprain and strain of the cervical spine category ranking first, followed by 145 patients (13.7%) who belonged to the sprain and strain of the lumbar spine, 632 patients (10.9%) with lumbar herniation of the intervertebral disk, and 557 patients (9.7%) with facial paralysis. It can be observed that the demand is high in conditions/diseases of the vertebrae, joint, and paralysis. The increase was also high in sprain and strain of the cervical spine (77.2 patients), followed by lumbar herniation of the intervertebral disk (50.3 patients), and facial paralysis (45.1 patients).
In case of sprains and strains, most patients were involved in a traffic accident. It is possible to conjecture the increase of patients choosing alternative medicine rather than Western medicine was associated with automobile insurance policies [
10]. In case of vertebral conditions/diseases, surgical treatment is recommended for severe symptoms, and a poor prognosis. However, in some cases Korean medicine treatment can be performed as conservative care before surgery, and the number of patients who seek Korean medicine for the purpose of rehabilitation after surgery is increasing [
14]. Demand for Korean medicine in a study was high in conditions/diseases that were not completely cured after using Western medicine surgery and drugs [
15]. Therefore, the number of patients who receive Korean medicine treatment for pain conditions/diseases is gradually increasing. In the case of facial paralysis, more patients are visiting Korean medicine hospitals whilst taking steroids for a better, and faster recovery.
The statistics on frequently presented condition/diseases showed that the tendency for visiting Korean medicine hospitals switched from the previous painful illnesses, chronic condition/diseases, anti-aging, lifestyle condition/diseases to conservative care for a specific diagnosis, treatment of injury, or rehabilitation after surgery. The number of patients seeking Korean medicine treatment is on the rise.
This study statistically analyzed patients who visited the Department of Acupuncture and Moxibustion Medicine, DaeJeon Korean medicine hospital, DaeJeon University in the past 5 years. However, this study used medical data from a single department at a single hospital, so it is difficult to generalize to the total condition/disease prevalence, or actual use of Korean medicine hospitals within a region or nationally. However, the tendencies of patients visiting Korean medicine institutions can be identified through this study and be used to guide the direction of future medical service. It provides basic data for qualifying medical treatment and can be used as an index for patients’ tendencies for visiting Korean medicine institutions, to be considered when making decisions for future studies or governmental policies for Korean medicine hospitals. Further study on the sociodemographic characteristics and usage of Korean medicine treatment is warranted.