Earticle

한국의 사망원인 1위를 차지하고 있는 암은 발병시 사망의 위험이 높기도 하지만 치료비의 부담과 생활비 충당 등 경제적 부담이 매우 큰 질병이다. 암보험을 통한 위험의 전가를 위하여 암보험 가입인구는 나날이 증가하고 있다. 한국에서는 1980년 최초로 암보험이 판매된 이후에 여러 차례 첨예한 보험분쟁을 겪었다. 그때마다 보 험회사는 법원의 판단을 받거나 감독기관의 개선명령 등을 통하여 암보험약관을 개 정하여왔다. 보험자는 2011년 4월에 개정된 암보험약관에서 “원발부위기준” 유의사 항을 신설하였고, 이를 근거로 갑상선암(C73)과 림프절 2차성암(C77)이 진단될 경우 원발암인 갑상선암(C73)을 기준으로 진단금과 치료비를 지급하고 있다. 문제는 원발 부위가 소액암일 경우 2차성암이 일반암 또는 고액암일 경우에도 보험자는 소액암진 단금을 지급하는 근거가 불명확하고 보험소비자의 불이익이 된다는 점이다. 이에 대 하여 하급심과 금융분쟁조정위원회 결정이 명확하지 않은 상황에서, 2021년 1월 보 험자는 원발부위기준을 다시 개정하였다. 설명란에서 원발부위기준이 적용되는 예시 를 3가지로 확대하였는데, 위암(C16)이 뇌로 전이되어 뇌암(C79.3)으로 진단받은 경우 위암으로 보고, 유방암(C50)이 폐로 전이되어 폐암(C78.0)로 진단된 경우에도 유 방암으로 본다는 내용이 추가되었다. 신체의 동일한 부위에 발생한 암이 원발성인가 2차성인가에 따라 치료나 예후 등으로 고려함이 없이 암보험금이 달리 지급되어야 할 합리적인 근거가 없다면, 이러한 원발부위기준은 보험소비자의 권리를 부당하게 제한하는 것으로 보아야 한다. 암보험약관은 사적자치의 원칙에 따라 보험자가 일방적으로 작성하여 사용할 수 있지만, “계약상대방의 정당한 이익과 합리적인 기대에 반하지 않고 형평에 맞게끔 약관조항을 작성하여야 한다”는 신의성실의 원칙에 반하는 약관조항은 법원에 의한 내용통제의 대상이 될 수 밖에 없을 것이다. 이 글은 암보험약관상 “원발부위기준”이 무엇이며 어떤 문제가 있는지를 보험자의 주장을 비판적 시각으로 분석하는 방법으로 연구하였다. 연구결과는 다음과 같다. 현 행 암보험약관상 “원발부위기준”은 삭제하고 환자(피보험자)의 최종상태 또는 병기를 기준으로 암보험금을 지급하는 것으로 변경하는 것이 바람직하며, 소액암으로 암진 단금을 받은 후 전이암(일반암 또는 고액암)이 진단되는 경우에는 각 진단금과의 차 액을 지급한다는 규정을 두는 것이 보험소비자의 합리적 기대에 부합하는 것이다.

Cancer, identified as the leading cause of death in South Korea, not only carries a high risk of fatality upon onset but also imposes significant economic burdens, including treatment expenses and costs for maintaining daily life. As a result, the number of individuals choosing cancer insurance to mitigate this risk is steadily rising. Since the introduction of cancer insurance in South Korea in 1980, numerous intense insurance disputes have emerged. In response, insurance companies have repeatedly revised their cancer insurance policy terms through court rulings and regulatory improvement orders. In 2011, insurance companies revised the cancer insurance policy terms by introducing the "Primary Site Criteria." According to this provision, in cases where thyroid cancer (C73) and secondary lymph node cancer (C77) are diagnosed, the primary cancer – in this case, thyroid cancer (C73) – is considered the basis for insurance benefit payouts. In situations where decisions from lower courts and financial dispute resolution committees are unclear, insurance companies revised the primary site criteria once again in January 2021 and expanded the examples illustrating the application of this criterion within the explanation section. For example, if stomach cancer (C16) metastasizes to the brain and results in a diagnosis of brain cancer (C79.3), it is categorized as stomach cancer for insurance coverage purposes. Similarly, if breast cancer (C50) metastasizes to the lungs and is diagnosed as lung cancer (C78.0), it is classified as breast cancer. This serves as a basis to provide reduced insurance benefits compared to the final diagnosed cancer. Should insurers fail to convincingly demonstrate a rational basis for distinguishing cancer insurance benefits based on whether the cancer originated primarily or secondarily in the same location, such actions should be deemed an unjust limitation on the rights of insurance consumers. While insurance policy terms can be unilaterally drafted and implemented by insurers based on the principle of private autonomy, any clauses contradicting the principle of utmost good faith – which mandates that terms and conditions should be drafted fairly and in line with the reasonable expectations and legitimate interests of the contracting parties without compromising fairness – are inevitably subject to judicial oversight. This paper critically analyzes insurers' arguments regarding the "Primary Site Criteria" within cancer insurance policy terms and sheds light on the issues at hand. The research results are as follows: It is advisable to eliminate the current "Primary Site Criteria" in the existing cancer insurance policy terms and instead transition to a payment structure for cancer insurance benefits based on the final condition or stage of the patient (insured). Moreover, in cases where a diagnosis of advanced cancer (general cancer or high treatment cost cancer) follows an early-stage cancer diagnosis benefit, it is in line with the reasonable expectations of insurance consumers to introduce a provision that ensures payment of the difference between the respective diagnosis benefits.

We aimed to examine various characterized features and effects of gender-associated different parameters including exercise on the prev-alence of colorectal cancer by using data from the National Health In-surance Sharing Service Database (NHISS DB). Data from NHISS were collected on Koreans aged from 40 to 85 years and were subject-ed to thematic analysis. The colorectal cancer codes (C19, C20, D011, and D012) from Korean Standard Classification of Disease and Causes of Death selected a target study group, and t-test and logistic regres-sion were used. As results, the age was higher for men who had col-orectal cancer than the noncancer group; however, high and low blood pres-sure, hemoglobin, and age had lower values for the cancer group com-pared to their counterparts in women. Only total cholesterol in men and waist size in women between cancer and noncancer groups were shown to have significant differences. Serum glutamic pyruvic trans-aminase and alanine aminotransaminase (SGPT_ALT) showed signifi-cant differences for both sexes. In exercise-related parameter, the re-sponse number 2 (1–2 times/wk, 0.535 for odd ratio) in women and re-sponse number 3 (3–4 times/wk, 0.466 for odd ratio) in men were asso-ciated with a reduced incidence of colon cancer. There was a dif-fer-ence in parameters in colorectal cancer patients over 40 years old for both sexes, but not in SGPT_ALT. Regular physical activity might be one of strong factors affecting or predicting colorectal cancer incidence.

보험계약은 장기계약이다. 그렇기 때문에 보험료를 계속적으로 납부하는 것이 중요하다. 그런데 중간에 보험료를 납부하다가 못내는 경우에 보험자는 한번 독촉을 하고 계약을 해지할 수 있다. 이 경우 해지되었지만 해지환급금이 반환되지 않은 상황에서 보험계약을 다시 살리는 제도로서 보험계약의 부활이 있다. 이 보험계약의 부활과 관련하여 분쟁이 다수 발생하고 있다. 부활시 약관설명의무, 고지의무이행이 문제가 되고 또한 암보험의 경우 90일의 대기기간도 문제가 된다. 보험계약을 부활할 경우에 원칙적으로 약관설명의무가 인정이 되고 또한 역선택을 막기 위하여 고지의무를 이행시키는 조치가 필요하다. 법원 판례에서는 자동차보험의 책임개시시기를 보험료를 납입한 날의 24시부터 보장이 개시된다는 내용이나 암보험의 90일 대기기간은 상법 제656조와는 달리 보험보장의 개시를 정하는 것이기 때문에 중요한 사항으로서 별도의 설명을 요한다고 하고 있다. 대법원 판결에서는 90일의 암보험 대기기간은 상법의 일반 조항과 다르게 책임의 개시시기를 정한 것으로 보험자가 구체적이고 상세한 설명의무를 지는 보험계약의 중요한 내용이라 할 것이고, 위 약관의 내용이 거래상 일반적이고 공통된 것이어서 보험계약자가 별도의 설명 없이도 충분히 예상할 수 있었던 내용이라 할 수 없다고 하였다. 보험계약의 부활의 경우에도 중요한 내용을 설명하여 주어야 한다. 물론 보험계약자가 그 내용을 잘 알고 있는 경우에는 설명하여 주지 않아도 된다. 이글에서 검토의 대상으로 삼은 A사의 분쟁사례에서는 보험자가 부활청약서에서 암 관련담보의 책임 개시일은 부활일로부터 해당 약관에 명시된 기간이 경과하여야만 효력이 발생함을 인지합니다라는 내용에 자필서명을 보험계약자로 하여금 하도록 하여 받았다. 그러나 그러한 자필서명만을 받은 것으로는 보험자의 상세한 설명의무를 다하였다고 보기는 어렵다. 따라서 이러한 경우라면 관련 대법원 판례의 취지에 비추어 보장게시를 위한 대기기간은 보험계약의 내용으로 주장하기 어렵다고 보아야 한다. 즉 대기기간중의 암진단의 경우에도 보험금을 지급하여야 한다. 비교법적으로 독일의 경우를 보면 독일에서는 대기기간의 기간을 문제 삼고 있다. 보험종목별로 차등화 된 대기기간 가운데 최대한 허용되는 기간을 법에서 명문으로 규정을 하고 동 규정을 편면적 강행규정으로 하고 있다는 점에 특징이 있다. 상법의 규정과 다른 내용은 대기기간의 경우는 별도로 상세히 설명하여 주어야 한다. 단순히 부활청약서에 기재해놓고 그에 대하여 확인서명을 했다고 해서 상세한 설명을 다하였다고 보기는 어렵다. 그리고 대기기간을 장기적으로는 상법 보험편에 명문으로 규정을 하는 것이 필요하다. 또한 상법 제656조를 고려하여 대기기간 불설명의 경우 보험계약자의 과실을 인정하여 과실상계를 허용하기는 어렵다고 보아야 한다. 무역보험에서도 부활제도의 적용은 가능하다. 다만 실제 무역보험 약관에서는 계약의 해제와 연관하여 연체보험료 납부를 규정하고 있다는 점에 특색이 있다. 보험계약의 부활시에 문제되는 점을 보험자와 계약자 모두 미리 확인하여 흠결이 없는 보험계약의 부활이 이루어지도록 노력을 기울여야 한다.

An insurance contract is a long - term contract. Therefore, it is important to pay the premium continuously. However, if the insurer fails to pay the premium in the middle, the insurer may terminate the contract at once. In this case, there is a resurrection of the insurance contract as a system to revive the insurance contract when the termination refund is not returned even though it was canceled. There are many disputes concerning the resurrection of this insurance contract. The obligation to explain the terms at the time of resurrection, the obligation to observe the obligation is a problem, and in the case of cancer insurance, the waiting period of 90 days is also a problem. In the case of resurrecting an insurance contract, in principle, the obligation to explain the terms is recognized and measures are required to fulfill the obligation to prevent reverse selection. In the court case, the guarantee period starts from 24:00 on the day of payment of the insurance premiums, but the 90-day waiting period of the cancer insurance is different from the Commercial Act Article 656, It is said that a separate explanation is required. In the Supreme Court's judgment, the 90-day waiting period for cancer insurance is different from the general provisions of the Commercial Act, which sets the time for the commencement of liability, which is the important content of the insurance contract for which the insurer has a detailed and detailed explanation obligation, And the insurance contractor can not be expected enough without any explanation. In case of resurrection of the insurance contract, it is also necessary to explain the important contents. Of course, you do not have to explain if the policy contractor knows the content well. In the case of A's dispute, which is the subject of review in this article, the insurer recognizes that the commencement date of the liability for cancer-related collateral in the revival subscription will be effective only after the period specified in the relevant clause has elapsed since the resurrection date. However, it is difficult to assume that the insurer's detailed explanation obligations have been fulfilled only by receiving such handwritten signatures. Therefore, in this case, it should be considered that the waiting period for posting the guarantee in the light of the purpose of the related Supreme Court precedent is difficult to claim as the content of the insurance contract. In other words, in the case of cancer diagnosis during the waiting period, insurance money. Compared to Germany, Germany has a problem of waiting period. It is characterized by the fact that the maximum amount of waiting period differentiated by insurance item is prescribed in the law and the regulations are made as the forced enforcement of the area. The provisions of the Commercial Act and other contents shall be explained separately in the case of the waiting period. It is difficult to say that a detailed explanation has been made simply because it is written on the resurrection application form and has been signed by him. In addition, it is necessary to prescribe the waiting period as a prestigious term in the commercial insurance section in the long run. In addition, considering Article 656 of the Commercial Code, it is difficult to recognize the negligence of the policyholder and allow for the negligence of offsetting in the case of the non-disclosure period. In trade insurance, the application of the resurrection system is possible. However, the actual trade insurance policy stipulates payment of delinquent premium in connection with cancellation of contract. Both the insurer and the contractor should check the problem in the resurrection of the insurance contract in advance and make efforts to resurrect the insurance contract without any defect.

선행연구에 따르면 건강충격의 영향은 개인의 사회경제적 자원 또는 사회제도에따라 다를 수 있다. 우리나라의 경우 사회보장제도만으로는 건강충격에 따른 의료비 지출과 상실소득을 충당할 수 없기 때문에, 민영의료보험에 대한 의존도가높다. 본 연구는 건강충격을 암 진단으로 정의하고 한국의료패널 2009~2018년자료에 패널사건사 분석을 적용하여, 암 진단이 의료이용과 개인 및 가구의 경제상태에 미치는 동태적 영향이 민영의료보험 보유여부에 따라 어떻게 다른지 살펴보았다. 분석 결과, 진료비는 보험보유 여부 또는 소득수준에 상관없이 암 진단이후 증가하나, 증가폭은 유보험 암환자에서 더 크며, 보험보유 여부별 차별적 의료이용은 상위 소득계층에서 두드러졌다. 또한, 암 진단 직후 유보험 암환자 가구의 총소득은 보험소득으로 인해 일시적으로 증가하고, 유보험 암환자의 근로소득감소폭은 무보험 암환자에 비해 크게 나타났다. 경제적 안전망 확충이 건강충격발생 시 의료이용과 노동공급에 대한 부담을 완화한 것으로 볼 수 있다.

Due to limited social protection, individuals in South Korea tend to purchase private health insurance which covers income loss as well as medical expenditures from health shock. This paper examines how the effects of cancer diagnoses on medical utilization, earnings, and household income vary with insurance status, using panel event study approach and data from Korea Health Panel from 2009 to 2018. We find that the increase in medical utilization following a cancer diagnosis is larger and more persistent for the insured, with smaller heterogeneous effects by insurance status for lower-income households. In addition, the insured experience larger decreases in earnings relative to the uninsured and temporary increases in household income with insurance payments but not among the uninsured.

이 논문은 2005년 시행된 암 보장성 강화정책이 의료이용과 건강성과에 미친 효과를 분석하였다. 건강보험 보장성 확대가 모든 질환에 대해 동일하게 이루어지지 않았다는 사실에 착안하여 이중차분 분석을 수행함으로써 정책의 순수한 효과를 추정하고자 시도하였다. 보장성 강화정책의 대상은 아니지만 중증질환인 간질환을 암 상병의 대조군으로 설정하고 의료이용에 미친 효과를 분석한 결과는 보장성 강화정책이 사회⋅경제적 인구 특성에 관계없이 암 환자들의 의료이용을 증가시키는 역할을 했을 가능성을 시사한다. 보장성 확대로 인한 의료이용 증가가 최종적인 건강성과를 개선시켰는지에 대한 연구 결과는 사회⋅경제적 인구 특성에 따라 상이했다.

This study analyzes the effects of the health insurance coverage expansion for cancer on health care utilization and health outcomes. Noting that the coverage expansion was not applied equally across all diseases, I employ the DID method using liver disease as a control group. The results indicate that the coverage expansion for cancer significantly increased health care utilization among cancer patients compared to liver disease patients. Importantly, the coverage expansion alleviated patients’ economic burden regardless of their age and income. However, the downstream impact of this improved health care utilization on probability of death differed depending on age and income.

Background: Diabetes is associated with cancer risk in the aging population. Observational studies have indicated the beneficial effects of metformin against breast cancer, making studies on the anticancer potential of antidiabetic drugs worthwhile. This study investigated cancer incidence in patients on antidiabetic monotherapy. Methods: Using National Health Insurance Service data (2002-2013), a retrospective cohort study that included type 2 diabetes mellitus (T2DM) patients was conducted. Study subjects were enrolled if they were ≥30 years old, on monotherapy for diabetes, and cancer-free. They were followed up for cancer occurrence or death, until December 31st, 2013. A Cox proportional hazard model analysis was conducted between metformin and sulfonylurea (including meglitinide) users, to determine cancer risk, with adjustment for age, gender, comorbidity index, dyslipidemia, hypertension, and T2DM duration. Results: The number of antidiabetic monotherapy-treated T2DM patients without a history of cancer was 9,554 (metformin, n = 5,825; sulfonylurea, n = 3,225; others, n = 504). During the follow-up period (mean, 2.04; IQR, 3.18 years), the cancer incidence rate was 5.48/100 and 5.45/100 patient-years for metformin and sulfonylurea, respectively. The hazard ratio (HR) for risk of cancer incidence in the metformin group was 0.74 (95% confidence interval [CI], 0.66-0.83; p < 0.0001), compared with sulfonylurea. Additionally, the HRs for risks of lung, liver, and stomach cancer were respectively 0.46 (95% CI, 0.31- 0.66; p < 0.0001), 0.41 (95% CI, 0.31-0.54; p < 0.0001), and 0.51 (95% CI, 0.35-0.73; p = 0.0003). Conclusion: Antidiabetic therapy with metformin reduces cancer risk by 26%, specifically for lung, liver, and stomach cancer.

Purpose: The purpose of this study is to assess appropriateness of current standard for insurance coverage by Health Insurance Review & Assessment Service (HIRA) on chemotherapy used in the treatment of advanced non-small cell lung cancer (NSCLC), by reviewing a variety of clinical evidences, and thereby, if needed, to propose an updated evidence-based recommendations. Methods: We collected data from HIRA regarding on the insurance standard which includes the scope and conditions for coverage on systemic chemotherapy of NSCLC. We performed a search for clinical databases and examined the most current clinical evidence from clinical literature including various clinical practice guidelines. Based on the collected data the appropriateness of HIRA standard for insurance coverage of chemotherapy of NSCLC was assessed. Results: Collected data demonstrated that HIRA standard did not reflect the most current clinical practice and evidence. Some were inappropriately listed in HIRA formulary and accepted as a chemotherapy being covered by insurance, despite the lack of evidences of clinical efficacy or superiority over other chemotherapeutic agents or regimens. In addition, there seems to be a need for a modification on the standard for insurance coverage of certain newer chemotherapeutic agents based on the current accumulated data showing their clinical efficacy and benefits in the selected group of NSCLC patients. Therefore, we concluded that current HIRA standard for insurance coverage on chemotherapy of NSCLC needs to be revised and we proposed an updated recommendation based on these latest clinical evidences. Conclusion: The standard for insurance coverage of chemotherapy should be continually examined its appropriateness based on the most recent clinical evidences in a timely manner so as to provide the most effective and safe therapy to cancer patients.

Background: Economic status is known to be directly or indirectly related to cancer incidence since it affects accessibility to health-related social resources, preventive medical checkups, and lifestyle. This study investigates the relationship between cancer incidence and family income in Korea. Methods:Using the Korean National Health Insurance cancer registration data in 2009, the relationship between their family income class and cancer risk was analyzed. The age-standardized incidence rates of the major cancers were calculated for men and women separately. After adjusting for age, residential area, and number of family members, cancer risks for major cancers according to family income class were estimated using a logistic regression model. Results: In men, the risk of stomach cancer for Income Class 5 (lowest) was 1.12 times (95% CI 1.02-1.23) higher than that of Income Class 1 (highest), for lung cancer 1.61 times (95% CI 1.43-1.81) higher, for liver cancer 1.22 times (95% CI 1.08-1.37) higher, and for rectal cancer 1.37 times higher (95% CI 1.18-1.59). In women, the risk of stomach cancer for Income Class 5 was 1.22 times higher (95% CI 1.08-1.37) than that for Income Class 1, while for cervical cancer it was 2.47 times higher (95% CI 2.08-2.94). In contrast, in men, Income Class 1 showed a higher risk of thyroid cancer and prostate cancer than that of Income Class 5, while, in women the same was the case for thyroid cancer. Conclusions: The results show the relationship between family income and cancer risk differs according to type of cancer.

Background: As coverage of public insurance is not sufficient to cover diagnosis or treatment of cancer, having private health insurance is important to prepare for unexpected expenses of cancer. The purpose of this study was to assess factors associated with having private cancer insurance, considering gender among the socio-demographic factors and health behavior. Materials and Methods: We used data from the 2011 Korea Health Panel, which included 10,871 participants aged 20 years and older. Socio-demographics, health behavior, and perceived cancer risk were the independent variables and having private cancer insurance was the dependent variable. Multivariable logistic regression analysis was used to identify factors associated with having private cancer insurance. Results: The variables relating to middle age, higher education, higher household income, married men, and the perceived cancer risk groups of 1-10% and 11-30% were significantly associated with having private cancer insurance. Additionally, females who had private non-cancer health insurance were positively associated with the dependent variables (OR=1.36; 95% CI=1.17-1.57). Education, smoking status, exercise, and perceived cancer risk possibility were significantly associated with having private cancer insurance only among women. The men lowered the overall percentages of those having private cancer insurance (OR=0.53, 95% CI=0.45-0.63). Conclusions: We found that there were significant differences between men and women who had private cancer insurance. Women with private cancer insurance are more likely to follow precautionary health behavior than men. This could be interpreted as resulting from masculine ideologies. It is important to make males recognize the seriousness of the cancer risk. In general, household income was highly associated with private cancer insurance. These results reveal an inequity among the buyers of private cancer insurance in terms of economic status level, education level, and health condition.

Although much health services research has been conducted using national health insurance claims data in Korea, the validity of this method has not been ascertained. The objective of this study was to validate the use of claims data for health services research by comparing incidence rate of cancers found using insurance claims data against rates of the national cancer registry of Korea. An algorithm to estimate incidence rates using claims data was developed and applied. The claims data from 2005-2008 were acquired and the patients admitted to hospitals due to cancer in 2008 without admission to hospital from 2005-2007 by the same diagnosis code were regarded as incident cases. The acquired results were compared with the values from the National Cancer Registry of Korea. The incidence rate of all cancers found using claims data was 363.1 per 100,000 people, which is very similar to the 361.9 per 100,000 rate of the national cancer registry. Also the age-, gender- and disease-specific rates between the two data sources were similar. Therefore, national health insurance claims data may be a worthwhile resource for health services research if appropriate algorithms are applied, especially considering the cost effectiveness of this method.

Cancer is the leading cause of death in the Republic of Korea and cancer death accounts for 27.8% of the total deaths, which is not only a social issue but also a concern for the public. Among the cancer death rates, lung cancer mortality account for 34 deaths per 100,000 populations, making it the number one cancer death rate. In a preliminary report on cancer death in 2012, the lung cancer mortality ratio showed the regional variation indicating that there were differences in the qualitative level and the structure among the medical care benefit agency and in the assessment of the treatment process. Therefore, the Health Insurance Review and Assessment Service (HIRA) had begun evaluation of the assessment of lung cancer treatment since 2014 to improve the quality of lung cancer care through evaluation and feeds back the results of lung cancer care process. In this report, authors described the current Indicators for the lung cancer adequacy assessment proposed by HIRA and results of the evaluation reported in 2017.

Purpose We aimed to determine the current application and survival trends of hematopoietic stem cell transplantation (HSCT) among Korean children and adolescents with cancer.Materials and Methods Data of patients aged < 20 years with KCD-10 (Korean Classifications of Diseases, 10th revision) C codes and specific designation codes were collected from the National Health Insurance Service database. Thirty claim codes for HSCT were included, and data from 2009 to 2019 were analyzed.Results The operational definition of pediatric cancer yielded an annual average of 2,000, with annual cases decreasing. In 2019, 221 HSCTs were performed, a decrease from the ten-year average of 276. Allografts outnumbered autografts with a ratio of 1.5:1. The source of allograft was bone marrow in 15% of patients in 2009; however, it substantially decreased to 3.3% in 2019. Furthermore, 70.5% of allogeneic HSCT used peripheral blood stem cell (PBSC) grafts, which increased to 89.3% by 2015. Cord blood utilization markedly decreased to 2.7% in 2018. The 5-year overall survival (OS) rate of all patients was 85.1%. Overall mortality decreased among patients who underwent recent HSCT, and they exhibited a higher 5-year OS rate.Conclusion In Korea, the number of pediatric patients with cancer is declining; however, the ratio of transplants to all patients remains constant. Patients who recently underwent transplantation showed better survival rates, possibly due to HSCT optimization. Korea showed a substantially greater PBSC utilization in pediatric HSCT. An in-depth examination encompassing donor relations and cause of death with a prospective registry is required in future studies.

Purpose This study investigated the risk of radiation-associated heart disease (RAHD) in Korean women treated with radiotherapy (RT) for breast cancer (BC) using data from the National Health Insurance Service database. Materials and Methods A retrospective cohort analysis was conducted on 65,188 patients with BC treated with RT between 2009 and 2014 and 325,940 controls without BC or prior coronary artery disease (CAD), with 1:5 exact matching by age, type 2 diabetes mellitus, hypertension, and dyslipidemia status. CAD encompassed both incident events and fatal events. Competing risk analysis was conducted to estimate subdistribution hazard ratio (HR) with 95% confidence interval (CI) for CAD, setting mortality from non-CAD causes as a competing risk. Results During the mean 9.9 years of follow-up period, 3,852 (1.0%) CAD and 20,999 (5.4%) death from non-CAD causes were reported. Compared to controls, participants with BC who received RT had a significantly lower risk of CAD incidence. HR (95% CI) for CAD in the BC with RT group was 0.66 (0.60-0.73, p < 0.001). On the other hand, HR (95% CI) for mortality from non-CAD causes was 3.57 (3.48-3.67, p < 0.001). Conclusion In this large population-based cohort study, BC patients who received RT did not show an increased incidence of CAD compared with the general population without BC. Individual-level dosimetric data and longer follow-up are needed to clarify the independent risk.

This study, using discrete choice experiments (DCE) method, tries to figure out the characteristics of the decision-making for cancer treatments and investigates the attributes affecting the respondents’ choice. Also it ascertains marginal willingness to pay (MWTP) and relative preferences for cancer treatments among the general population. The nested-logit model using full maximum likelihood allows us to estimate multi-levels of dependent variables. The empirical results show that the respondents are willing to pay more about 20.8% than they are paying now in order to increase their expected survival rate by 10 percentage points. The paper also considers the effect of several individual and socio-economic variables on the size of MWTP of insurance premium for increasing cancer survival rates. Most interestingly, the MWTP is shown to be monotonically decreasing as the people became old. We also found out that there exists severe discrepancy of estimates of MWTP of between payers and dependents and across different occupational groups.

PurposeThis study aimed to assess the feasibility of operational definitions of cancer patients in conducting cancer-related studies using the claims data from the National Health Insurance Service (NHIS). Materials and MethodsCancer incidence data were obtained from the Korean Central Cancer Registry, the NHIS primary diagnosis, and from the rare and intractable disease (RID) registration program.ResultsThe operational definition with higher sensitivity for cancer patient verification was different by cancer type. Using primary diagnosis, the lowest sensitivity was found in colorectal cancer (91.5%; 95% confidence interval [CI], 91.7 to 92.0) and the highest sensitivity was found in breast cancer (97.9%; 95% CI, 97.8 to 98.0). With RID, sensitivity was the lowest in liver cancer (91.9%; 95% CI, 91.7 to 92.0) and highest in breast cancer (98.1%; 95% CI, 98.0 to 98.2). In terms of the difference in the date of diagnosis in the cancer registration data, > 80% of the patients showed a < 31-day difference from the RID definition. ConclusionBased on the NHIS data, the operational definition of cancer incidence is more accurate when using the RID registration program claims compared to using the primary diagnosis despite the relatively lower concordance by cancer type requires additional definitions such as treatment.

Background: Public use National Health and Nutrition Examination Survey (NHANES III) and NHANES III linked mortality data were here applied to investigate the association between health insurance coverage and all cause and all cancer mortality in adults. Patients and Methods: NHANES III household adult, laboratory and mortality data were merged. Only patients examined in the mobile examination center (MEC) were included in this study. The sampling weight employed was WTPFEX6, SDPPSU6 being used for the probability sampling unit and SDPSTRA6 to designate the strata for the survey analysis. All cause and all cancer mortalities were used as binary outcomes. The effect of health insurance coverage status on all cause and all cancer mortalities were analyzed with potential socioeconomic, behavioral and health status confounders. Results: There were 2398 sample persons included in this study. The mean age was 40 years and the mean (S.E.) follow up was 171.85 (3.12) person months from the MEC examination. For all cause mortality, the odds ratios (significant p-values) of the covariates were: age, 1.0095 (0.000); no health insurance coverage (using subjects with health insurance), 1.71 (0.092); black race (using non-Hispanic white subjects as the reference group) 1.43, (0.083); Mexican-Americans, 0.60 (0.089); DMPPIR, 0.82, (0.000); and drinking hard liquor, 1.014 (0.007). For all cancer mortality, the odds ratio (significant p-values) of the covariates were: age, 1.0072 (0.00); no health insurance coverage, using with health coverage as the reference group, 2.91 (0.002); black race, using non-Hispanic whites as the reference group, 1.64 (0.047); Mexican Americans, 0.33 (0.008) and smoking, 1.017 (0.118). Conclusion: There was a 70% increase in risk of all cause death and almost 300% of all cancer death for people without any health insurance coverage.

Purpose: In Korea, the entire population must enroll in the national health insurance system, and those who are classified as having a lower socioeconomic status are supported by the medical aid system. The aim of this study was to evaluate the association of the medical insurance status of gastric cancer patients with their survival after gastrectomy. Materials and Methods: A total of 247 patients who underwent surgical treatment for gastric cancer between January 1999 and December 2010 at the Seoul Medical Center were evaluated. Based on their medical insurance status, the patients were classified into two groups: the national health insurance registered group (n=183), and the medical aid covered group (n=64). The survival rates were calculated using the Kaplan-Meier method. Results: The median postoperative duration of hospitalization was longer in the medical aid covered group and postoperative morbidity and mortality were higher in the medical aid group than in the national health insurance registered group (P<0.05). The overall 5-year survival rate was 43.9% in the medical aid covered group and 64.3% in the national health insurance registered group (P=0.001). Conclusions: The medical insurance status reflects the socioeconomic status of a patient and can influence the overall survival of gastric cancer patients. A more sophisticated analysis of the difference in the survival time between gastric cancer patients based on their socioeconomic status is necessary.