= Ab stract = A S t u dy o n t h e M e di c a l In s u r an c e U t i li z at i o n o f W o rk e r s S u f f e rin g f ro m L o w B ac k P ain in an A re a Chul Gab Lee Hyun Ok Ahn So Yeon Ryu Jong Park Ki Soon Kim Yang Ok Kim D epartm ent of P reventive M edicine, Colleg e of M edicine, Chos un University T o fin d th e m edical in sur an ce utilization of w orker s w h en sufferin g fr om low back pain, an analy sis w a s m ade tow ard the data of medical in surance benefits m atched w ith the gen eral characteristics of 10,183 w orker s, w h o w ere registered continuou sly from 1993 to 1995 at a m edical in suran ce cooperation for indu strial w orker s. T he result s w ere as follow s ; 1. T he period pr ev alence of th e m edical in sur ance utilization for low b ack pain for 3 y ear s from 1993 to 1995 w as calculated as 17.1% for m ale w orkers and 19.4% for fem ale w orker s. M ost comm on cau se of utilization w as oth er dor sopathies in clu din g the h erniation of lum bar discs. 2. T he utilization r at e in cr eased significantly as th e present age an d the age joinin g the company g ot older (p < 0.001). A s the duration of employm ent g ot lon ger, th e utilization rate of the m ale show ed the ten dency to incr ea se and that of th e fem ale increased significantly (p< 0.05). A mong male w orkers employ ed at cem ent an d concrete m anufacturing companies show ed high er utilization rate and am on g fem ale laborer s
show ed significantly higher utilization r ate than clerical w orker s (p< 0.01). 3. Annu al utilization r ate for low back pain didn ' t sh ow any differ en ce, but th e portion of other dor sopathies among cau se of utilization show ed the ten dency to increase from 1993 to 1995. 4. T he m ean number of claim s for outpatient m edical care for low back pain differed significantly by ag e, w orkin g dur ation, type of in du stries, incom e lev el(p < 0.05), and the m ean of t ot al visiting day s for car e of low back pain differ ed siginificanly by w orkin g duration. In con clu sion, con siderin g the fact that th e m edical in sur an ce utilization for low b ack pain increased annually and other dor sopathies including the herniation of dor sopathies w ere increa sin g, an effectiv e prev entiv e or manag em ent program for low back pain tow ard w ork er employ ed at indu stries w ere required. Key w ords ; medical care utilization, utilization rate, low back pain, in du strial w orker s * 1996.
. (Sn ook, 1982),. (low back pain ),,.,. 25-68% (, 1989;, 1993;, 1993), 15-30% (, 1985;, 1990;, 1994).,..,.,.,.. (strain ), (m echanical),, (spon dyloarthropathies ),, (W alter, 1994).,,, (, 1995). 60-80%
(Skovron, 1994; M as set, 1994; F rym oy er, 1983),, (m edical interv ention ) (W alter, 1994). (Korean Stan dard Classification of Disea se, KCD ) 3 (, 1993).,.
. 1..,,, 14 (, 1992), 1993 1 1 1995 12 31 26,928 3 8,783, 1,400, 10,183. 2. 1),, 1993 1 1 1995 12 31 3, 1995,. 1993-1995 - -, -, - 1993-1996 -, -, ( / ),,, - 1995 -,
2 ) 1993 1 1 1995 12 31. 1993 1996 1993 1 1 1995 12 31,,,,,,. 1993 1995 KCD 2 (ICD - 9) KCD 3 (ICD - 10) KCD 2-3 KCD 3. KCD (1), (2), (3) 3 (block s of categories ), KCD T able 1. (other interv ertebral disc disorder ), (, 1993) KCD. T able 1. K CD c odes as c ateg ory of low back pain. Disease of the musculoskeletal system and connective tissue (1) D eform ing dors opathies M40 Kyphosis & lordosis M41 Scoliosis M43 Other deforming dor sopathies M45 Analysing spondylitis M47 Spondylosis M48 Other sopndylopathies (2) Other dors opathies M51 Other intervertebral disc disor ders M53 Other dorsopathies, NEC M54 Dorsalgia Injury, poisoning & certain other consequences of external causes (3 ) S prain & s train of lum bar s pine (S33.5),,,,
,,.,, 1993, 1994, 1995 3,,, 3,,,,,.. 3 F ig. 1. D at a of m e dic al in s uranc e qu alific ation m an ag em ent 1. Com pany num ber 2. ID number 3. N am e 4. Date of acquiring qualification 5. Date of losing qualification 5. Salary D ata of m e dic al in s uranc e b enifit s from 1993 t o 1996 1. ID number 2. M edical car e institution num ber 3. KCD code 4. In/ out patient s 5. T r eatm ent day s 6. Days of m edication (adm ission/ visit ) H ealth ex am ination data of w orkers in 1995 1. ID number 2. T ypes of job P ers onal databas e of the s ubjects Com pany num ber ID number Sex Age W orking duration T ypes of job Patients or non - patients T reatment type (In- / out patients) T reatment days or vigiting days Medical expenses F ig 1. B rief outline of pers onal databas e of the s ubjects 3 1, 1, 2, 1. 1993 1994 1995 1993 1995 3 1, 1
.,., 3 1995. 4 25%, 25%, 3, 1,020,000 1,400,000, 430,000 690,000. 3 ),,,,, -,,,, tren d test.,,,,, (ANOVA ). 4 ) ; 1993 1995 3 1993, 1994, 1995 1 1. 3 : : 3 1,,,,, : : (1994, 1995 ) (1993, 1993 1994 )
. 1.,,,, T able 2. 30-39 57.2%, 29 39.8%. 29 76.6%, 30 55.3%,. 5-10 48.2%, 10. 77.9%, 42.7%. 9.0%, 6.9%, 10.1%,.
T able 2. General characteris tic s of the s ubjects un it : pe rson(%) M ale F e m ale T ot al A g e (y e ar) - 29 1,427 ( 16.2) 557 ( 39.8) 1,984 ( 19.5) 30-39 5,028 ( 57.2) 160 ( 11.4) 5,188 ( 50.9) 40-49 1,559 ( 17.8) 451 ( 32.2) 2,010 ( 19.7) 50-769 ( 8.8) 232 ( 16.6) 1,001 ( 9.9) A g e j oin ing c om p an y (y e ar ) - 29 6,730 ( 76.6) 625 ( 44.7) 7,355 ( 72.2) 30-39 1,613 ( 18.4) 412 ( 29.4) 2,025 ( 19.9) 40-49 338 ( 3.8) 304 ( 21.7) 642 ( 26.3) 50-102 ( 1.2) 59 ( 4.2) 161 ( 1.6) W orking duration (y ear) 3-4 2,107 ( 24.0) 635 (45.4) 2,742 (26.9) 5-9 4,236 ( 48.2) 633 (45.2) 4,869 (47.8) 10-14 1,076 ( 12.3) 109 ( 7.8) 1,185 (11.7) 15-1,364 ( 15.5) 23 ( 1.6) 1,387 (13.6) Indu s trie s Autom obil & accessory 6,839 ( 77.8) 188 ( 13.4) 7,027 ( 69.1) Spinning & finishing of textiles 282 ( 3.2) 598 ( 42.7) 880 ( 8.6) Cement concrete goods 656 ( 7.5) 109 ( 7.8) 765 ( 7.5) Others 1,006 ( 11.5) 505 ( 36.1) 1,511 ( 14.8) Job s Clerk 791 ( 9.0) 126 ( 9.0) 917 ( 9.0) Laborer 7,388 ( 84.1) 1,132 ( 80.9) 8,520 ( 83.7) Unknow n 604 ( 6.9) 142 ( 10.1) 746 ( 7.3) Inc om e Upper Class 2,775 (31.6) 402 (28.7) 3,177 (31.2) Middle Class 4,310 (49.1) 684 (48.9) 4,994 (49.0) Low er Class 1,698 (19.3) 314 (22.4) 2,012 (19.8) T otal 8,783 (100.0) 1,400 (100.0) 10,183 (100.0) 2.. 3 1993 1995 3 T able 3. 87.9%, 87.3% 1,
17.1%, 19.4%, 19.5%, 22.3%., 11.5%, 17.1%. T able 3. U tlitization rate for LB P during 1993-1995 M ale No (%) F em ale No (%) S ubject s 8,783 (100.0) 1,400 (100.0) T ot al Patient s 7,716 ( 87.9) 1,222 ( 87.3) L ow b ac k pain * 1,502 ( 17.1) 272 ( 19.4) Deform ing dors opathies 379 ( 4.3) 76 ( 5.4) Ot he r d ors opath ie s 1,007 ( 11.5) 240 ( 17.1) Sprain of lum bar spine 920 ( 10.5) 129 ( 9.2) L B P/ T ot al patie nt s (%) 19.5 22.3 * Dup l icat ed case among 3 d isease group we re exc luded. T able 4..,..
T able 4. Ex perienc e of utiliz ation by characteris tic s of the s ubjects during 1993-1995 un it ; pe rson (%) M ale F e m ale U tiliz ation (+ ) U t iliz at ion (- ) U t iliz at ion (+) U tiliz ation (- ) A g e (y e ar ) - 29 212 (14.9) ** 1,215 (85.1) 56 (10.1) ** 501 (89.9) 30-39 835 (16.6) 4,193 (83.4) 27 (16.9) 133 (83.1) 40-49 275 (17.6) 1,284 (82.4) 120 (26.6) 331 (73.4) 50-180 (23.4) 589 (76.6) 69 (29.7) 163 (70.3) A g e j oin ing c om p an y (y e ar) - 29 1,089 (16.2) ** 5,641 (83.8) 67 (10.7) ** 558 (89.3) 30-39 304 (18.8) 1,309 (81.2) 101 (24.5) 311 (75.5) 40-49 81 (24.0) 257 (76.0) 84 (27.6) 220 (72.4) 50-28 (27.5) 74 (72.5) 20 (33.9) 39 (66.1) W orking duration (y ear ) 3-4 334 (15.9) 1,764 (84.1) 106 (16.5) 538 (83.5) 5-9 722 (16.8) 3,576 (83.2) 124 (21.7) 447 (78.3) 10-14 199 (19.0) 846 (81.0) 33 (23.6) 107 (76.4) 15-247 (18.4) 1095 (81.6) 9 (20.0) 36 (80.0) In du s trie s Autom obil & accessories 1,124 (16.4) # 5,715 (83.6) 29 (15.4) 159 (84.6) Spinning & finishing of textiles 46 (16.3) 236 (83.7) 116 (19.4) 482 (80.6) Cement concrete goods 147 (22.4) 509 (77.6) 24 (22.0) 85 (78.0) Others 185 (18.1) 821 (81.6) 103 (20.4) 402 (79.6) Job s Clerk 122 (15.4) 646 (81.7) 10 ( 7.9) # 116 (92.1) Laborer 1,292 (17.5) 5,833 (79.0) 237 (20.9) 895 (79.1) Unknow n 88 (14.6) 487 (80.6) 25 (17.6) 117 (82.4) In c om e Upper Class 292 (17.2) 1,342 (79.0) 51 (16.2) 263 (83.8) Middle Class 702 (16.3) 3,447 (80.0) 131 (19.2) 553 (80.8) Low er Class 508 (18.3) 2,177 (78.5) 90 (22.4) 312 (77.6) T otal 1,502 (17.1) 7,281 (82.9) 272 (19.4) 1,128 (80.6) * p<0.05, ** p<0.01 2 - t es t for t rend, # p<0.0 1 2 - t est. F ig. 2 Fig. 3. 1993 6.6%, 1994 7.2%, 1995 7.1%, 1993 7.4%, 1994 8.1%, 1995 9.5%, 1993, 1994, 1995 2.4%, 2.9%, 4.6%, 3.0%, 4.5%, 7.5%.
* D up licated case of LB P am ong 3 disease g roup were ex cluded F ig. 2. U tiliz ation rate by y ear (m ale ) * D up licated case of LB P am ong 3 disease g roup were ex cluded F ig. 3. U tilization rate by y ear (fem ale ) Fig. 4 Fig. 5. 1994 5.8%, 1995 9.8%, 6.6%, 12.5% 1994 1995..
* D up licated case of LB P am ong 3 disease g roup were ex cluded F ig 4. Incidenc e of LB P by y ear (m ale ) * D up licated case of LB P am ong 3 disease g roup were ex cluded F ig 5. Incidenc e of LB P by y ear (fem ale ) 3.. 3 1993 1995 3 T able 5.
3.3%, 3.5% 5.1%, 6.3%. 2.6% 6.6%. T able 6 76.7%, 79.0%, 50.0% 55.7%, 34.9%, 30.7%, 15.1%, 13.6%. T able 5. Proportion of m edic al ins uranc e utlitization & m edic al ex pens es for LB P am ong total utilization during 1993-1995 Claim s In - P at ien t s T re atm e nt d ay s M e dic al e x pen s e s un it ; numbe r, day, 1,000won (%) Out - P at ie n t s Claim s D ay s of v is it M e dic al e x pen s e s T ot al patie nt s 918 (100.0) 8,,568 (100.0) 647,077 (100.0) 80,874 (100.0) 16,5716 (100.0) 2,330,190 (100.0) L ow b ac k pain 30 ( 3.3) 300 ( 3.5) 16,781 ( 2.6) 4,164 ( 5.1) 10,448 ( 6.3) 153,025 ( 6.6) T able 6. A m ount of m edic al ins uranc e utilization for LB P by dis eas e c arteg ories during 1993-1995 Claim s In - P atie nt s T re at m e nt d ay s un it ; numbe r, day (%) Ou t - P atie nt s Claim s D ay s of v is it L ow b ac k pain 30 ( 100.0) 300 ( 100.0) 4,164 ( 100.0) D eform ing dors opathie s 0 0 632 (15.1) Oth er d ors opath ie s 23 (76.7) S prain of lum b ar s pin e 7 (23.3) 237 (79.0) 63 (21.0) 2,081 (50.0) 1,451 (34.9) 10,448 (100.0) 1,416 (13.6) 5,815 (55.7) 3,217 (30.7). 1 T able 7,,,, 1.
T able 7. A m ount of utlitization for LB P during 1993-1995 A g e (y e ar) un it ; numbe r, day In - p atien t s (m e an/ p atien t s ) Out - p atien t s (m e an/ p atien t s ) Patients Claim s Day s of t ot al adm is s ion Patients Claim s Day s of t ot al v is it - 29 3 3 (1.0) 51 (17.0) 267 619 (2.3) * 1,589 (5.9) 30-39 14 16 (1.1) 117 ( 8.4) 860 1,937 (2.2) 4,799 (5.6) 40-49 6 6 (1.0) 69 (11.5) 395 897 (2.3) 2,290 (5.8) 50-4 4 (1.3) 5 (15.8) 249 711 (2.9) 1,779 (7.1) A g e j oinin g c om pany (y e ar) - 29 16 18 (1.1) 154 (9.6) 1,153 2,634 (2.3) 6,541 (5.7) 30-39 10 11 (1.1) 135 (13.5) 405 960 (2.4) 2,634 (6.3) 40-49 0 0 (0.0) 0 (0.0) 165 437 (2.7) 1,047 (6.4) 50-1 1 (1.0) 11 (11.0) 48 133 (2.8) 337 (7.0) W orking duration (y ear) 3-4 6 7 (1.2) 81 (13.5) 439 951 (2.2) * 2,264 (5.2) * 5-9 14 15 (1.1) 123 (8.8) 844 2,031 (2.4) 5,157 (6.1) 10-14 2 2 (1.0) 29 (14.5) 232 499 (2.2) 1,219 (5.3) 15-5 6 (1.2) 67 (13.4) 256 683 (2.7) 1,817 (7.1) In du s trie s Automobil & accessories 15 18 (1.2) 173 (7.8) 1,151 2,607 (2.3) * 6,483 (5.6) Spinning & finishing of textiles 3 3 (1.0) 43 (6.8) 162 464 (2.9) 1,248 (7.7) Cement concrete g oods 5 5 (1.0) 52 ( 8.1) 171 405 (2.4) 946 (5.5) Others 4 4 (1.0) 32 ( 2.9) 287 688 (2.4) 1,780 (6.2) Job s Clerk 4 6 (1.5) * 57 (14.3) 132 315 (2.4) 879 (6.7) Laborer 17 18 (1.1) 167 ( 9.8) 1,528 3,572 (2.3) 8,883 (5.8) Unknow n 6 6 (1.0) 76 (12.7) 111 277 (2.5) 695 (6.3) In c om e Upper Class 8 9 (1.1) 89 (12.3) 343 780 (2.5) * 2,106 (6.1) Middle Class 7 8 (1.1) 64 ( 9.1) 832 1,883 (2.3) 4,719 (5.7) Low er Class 12 13 (1.1) 147 (11.1) 596 1,501 (2.4) 3,632 (6.1) T otal 27 30 (1.1) 300 (11.1) 1,771 4,164 (2.4) 10,457 (5.9) * p<0.05, ANOVA t est
. T able 8 T able 9. 1993 1994 1995 2,.,,. T able 8. A m ount of utlitiz ation by y ear as LB P (In - P atients ) Low In - P atie nt s B ack Pain P atie nt s S um of Claim s (m e an/ p at ie n t s ) un it : pe rson, numbe r, day S u m of D ay s (m e an/ p at ie n t s ) 199 3 199 4 19 95 19 93 1994 1995 1993 19 94 199 5 7 7 13 8 (1.1) 7 (1.0) 15 (1.2) 81 (11.6) 74 (10.6) 145 (11.2) D eform ing dors opathie s 0 0 0 0 0 0 0 0 0 Oth er d ors opath ie s 5 5 10 6 (1.2) 5 (1.0) 12 (1.2) 45 ( 9.0) 62 (12.4) 130 (13.0) S prain of lum b ar s pine 2 2 3 2 (1.0) 2 (1.0) 3 (1.0) 36 (18.0) 12 ( 6.0) 15 ( 5.0) T able 9. A m ounts of utlitiz ation by y ear as LB P (Out - P atients ) Out - P at ie n t s L ow - B ac k P ain P atie nt s S um of Claim s (m e an/ p at ie n t s ) un it : pe rson, numbe r, day S um of V is itin g (m e an/ patie nt s ) 199 3 199 4 19 95 19 93 1994 1995 19 93 19 94 199 5 686 743 758 1,283 (1.9) D eform ing dors opathie s 185 197 58 265 (1.4) Oth er d ors opath ie s 249 323 513 520 (2.1) S prain of lum b ar s pine 355 346 279 498 (1.4) 1,375 (1.9) 276 (1.4) 590 (1.8) 509 (1.5) 1506 (2.0) 91 (1.6) 971 (1.9) 444 (1.6) 3,590 ( 5.2) 574 ( 3.1) 1,798 ( 7.2) 1,218 ( 3.4) 3,419 ( 4.6) 648 ( 3.3) 1,678 ( 5.2) 1,093 ( 3.2) 3,448 ( 4.6) 194 ( 3.3) 2,348 ( 4.6) 906 ( 3.3)
. (n eed ),,,,,, (, 1996).., 1993 1995 3....,,. KCD 3 (three- ch aracter categories ) 4 (block s of categories ),..,,,. 3 8,783 7,716, 1,400 1,222 3 87.9%, 87.3%, 17.1%, 19.4%,
19.5%, 22.3%. 1,,,. 30 40 (Sn ook, 1982; Leigh, 1989; Kelsey, 1990), (M adora, 1969; Gibber, 1982) (T abula, 1982; W ash, 1989) (, 1993). 3,, 1995.,, (p< 0.001).,. (1993),, (, 1993). 20%, 40% 10%, 20% (, 1993),.. (1996) 25%, 25%,., (1996) 3,.,,,., (, 1993), (, 1993) (Kelsey, 1975)
,. 77.9% 13.4%.,,,,. 3.3%, 5.1%, 2.6% 6.6%., 1994 4,638 (, 1995) 264. (1994) 1,480, 1800. (1996), (Back School Program ), - 3.90-6.28,,. 1993 1995 6.6%, 7.2%, 7.1%, 7.4%, 8.1%, 9.5%, 1994, 1995 5.7% 5.8%, 6.6% 6.9%, (disability ).,,,,, KCD 2 3.,
( )., (W alter, 1994),.,.,,.
. 1993 1995 8,783, 1,400 10,183,,. 1. 1993 1995 3 17.1%, 19.4%,. 2. (p< 0.001).,. (p< 0.01), (p < 0.01). 3. 1993 1995 3,. 4.,,, 1 (p < 0.05), 1.(p < 0.05).,.
,,,,,.. 1993; 26(1) : 20-36,., 2n d ed., 1996. 624-652.. 1993... 1993; 26 (1) : 47-48,,,,,.. 1994; 27 (2) : 229-312.. 1989; 28(1) : 14-24.., 1995. 291-305. 94., 1995.,,,,,.. 1993; 26 (4) : 574-586.. 1985; 6 (3): 437-447,,,,,,. -. 1996; 29 (2) : 347-357.. 1992.. (case- mix ). 1996. Gib eau C. R eview of w ork related back inj uries : R ep ort of the R es earch S ection. A lberta, Canada, Occup ational H ealth S af ety 1982 Kelsey JL, Golden AL, Mun dt DJ. L ow back p ain p rolap s ed lum bar interv ertebral d is c. R heum - D is - Clin - N orth-a m 1990;16(3) :699-716 Leigh JP, Sheett RM. P revalence of back p ain am ong f ulltim e United S tates w ork ers. B rit J of I nd M ed 1989;46:651-657 M ag ora A. I nv es tig ation of the relation betw een low back p ain and occup ation. I nd us trial M ed 1970;39(11) :465-4 77 Snook SH. L ow back p ain in ind us try, in Gord on S L (eds) : Sy mp os ium on id iop athic low back p ain, M os by S t L ouis 1982,pp 23 Snook SH. L ow back p ain in ind us try, in Gord on S L (eds) : Sy mp os ium on id iop athic
low back p ain, M os by S t L ouis 1982,pp 23 T ak ala J, Siev er s K, Klaukk a T. R heum atic sy mp tom s in the m iddle - ag ed p op ulation in s outhw es tern F inland. S cand J R heum atol S upp l 1982 ;12 :469-4 72 W alter L, Calm bach. D is orders of the B ack and N eck. F am ily M edicine - p rincip les & p ractice. 4 th ed. N ew Y ork, Sp ring er- V erlag, 1994 : 856-866 W alsh K, Varnes N, Osm ond C, Styles R : Occupational caus es of low back pain. S cand J W ork env iron. health 1989;15 :54-59 de Girolam o. Ep id em iology and s ocial cos ts of low back p ain and f ibrom yalg ia. Clin - J - P ain 1991;7 S upp l:s 1-7