Herbal decoctions for dysmenorrhea under universal health coverage pilot project: Evidence from a nationwide claims database in the Republic of Korea

초록

Background: Despite its high prevalence, dysmenorrhea is an underestimated gynecological disorder. To enhance the service coverage, the Pilot Project for Expanding National Health Insurance (NHI) Coverage to Herbal Decoctions (HDs) was implemented in the Republic of Korea from November 2020. This study aimed to assess the effectiveness and safety of HDs for dysmenorrhea at a nationwide level. Additionally, its impact on accessibility was explored. Methods: This retrospective observational study used claims data from the pilot project (November 1, 2020, to April 28, 2024). A linear mixed-effects model was used to estimate symptom improvement during the HD exposure period. Time series data decomposition and structural change points detection were performed using NHI statistics on dysmenorrhea patient counts for those who received medical services between 2014 and 2023. Results: Among 39,574 participants, a descriptive analysis of 7016 suggested a tendency to receive HD treatment for moderate-to-severe symptoms. Effectiveness analysis demonstrated that HD significantly reduced symptom severity over time (beta = -0.072, p < 0.001). Adverse events were reported by 0.58 % of the patients, mostly involving gastrointestinal symptoms. Following the initiation of the pilot project, a significant increase in the number of patients with dysmenorrhea receiving traditional Korean medicine (TKM) services was observed. Conclusion: The nationwide pilot project showed clinical effectiveness and a manageable safety profile of HDs for dysmenorrhea. The universal health coverage initiative appeared to have improved the accessibility of TKM services for managing dysmenorrhea. Further robust research utilizing nationwide real-world data is required to validate these findings.

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