{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T20:20:48Z","timestamp":1788294048789,"version":"build-2803163510"},"reference-count":16,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Ministry of Health & Welfare, Republic of Korea","award":["RS 2021 KH110758"],"award-info":[{"award-number":["RS 2021 KH110758"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,15]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine trends in Chuna manual therapy utilisation for musculoskeletal disorders (MSDs) following its inclusion in the National Health Insurance (NHI) system in Korea in 2019 using claims data from the Health Insurance Review &amp; Assessment Service (HIRA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective analysis of NHI claims data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Nationwide medical institutions, based on HIRA claims data from April 2019 to December 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All patients who received at least one Chuna therapy session during the study period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Primary outcome: Annual trends in Chuna manual therapy claims. Secondary outcome: Patient demographics, therapy frequency, MSD diagnoses and concurrent therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 12\u2009729\u2009625 Chuna therapy claims were analysed, showing a gradual annual increase in utilisation from 2019 to 2021. The most common age group was 45\u201354 years (22.3%), with female patients comprising a higher proportion (55.8%) than male patients.<\/jats:p>\n                    <jats:p>Low back pain (M54.5), lumbar sprain and strain (S33.5) and cervicalgia (M54.2) were the most common diagnoses. Patients receiving Complex Chuna (50% co-payment) had more treatment sessions than those receiving Simple Chuna or Complex Chuna (80% co-payment), with spinal disorders such as spinal stenosis (M48.0) and intervertebral disc disorders (M51.1, M50.1) associated with higher treatment frequency. Acupuncture was the most common concurrent therapy (97.4%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study is the first to comprehensively analyse Chuna therapy utilisation using nationwide NHI claims data. The findings confirm that Chuna therapy is widely used for MSDs, particularly among middle-aged and elderly patients with spinal or muscle-related conditions. Patients with severe or chronic spinal diseases were more likely to receive frequent Chuna therapy sessions. These results provide insights into the utilisation patterns of Chuna therapy and highlight the need for further research to refine reimbursement policies based on disease severity and patient characteristics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-094099","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T10:25:13Z","timestamp":1754648713000},"page":"e094099","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Analysis of the utilisation of Chuna manual therapy for musculoskeletal disorders after its coverage under national health insurance in Korea: a retrospective analysis"],"prefix":"10.1136","volume":"15","author":[{"given":"Gil Geun","family":"Baek","sequence":"first","affiliation":[{"name":"Jaseng Hospital of Korean Medicine, Gangnam-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5020-6723","authenticated-orcid":false,"given":"In-Hyuk","family":"Ha","sequence":"additional","affiliation":[{"name":"Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Gangnam-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1532-0942","authenticated-orcid":false,"given":"Yoon Jae","family":"Lee","sequence":"additional","affiliation":[{"name":"Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Gangnam-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeong-Jae","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Korean Medicine Rehabilitation, Pusan National University Korean Medicine Hospital, Yangsan-si, Gyeongsangnam-do, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung-Cheul","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Korean Medicine Rehabilitation, Pusan National University Korean Medicine Hospital, Yangsan-si, Gyeongsangnam-do, Korea (the Republic of)"},{"name":"Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Gyeongsangnam-do, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"2025123106454167000_15.8.e094099.1","doi-asserted-by":"publisher","DOI":"10.1590\/S0042-96862003000900007"},{"key":"2025123106454167000_15.8.e094099.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32340-0"},{"key":"2025123106454167000_15.8.e094099.3","unstructured":"World Health Organization . Musculoskeletal health. World Health Organization; 2022. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/musculoskeletal-conditions"},{"key":"2025123106454167000_15.8.e094099.4","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.jcot.2021.04.021","article-title":"Complementary and Alternative Modalities (CAM) for pain management in musculoskeletal diseases (MSDs)","volume":"18","author":"Bhoi","year":"2021","journal-title":"J Clin Orthop Trauma"},{"key":"2025123106454167000_15.8.e094099.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1836-9553(11)70002-9"},{"key":"2025123106454167000_15.8.e094099.6","unstructured":"Korean Society of Chuna Manual Medicines for Spine & Nerves 2.5th. Chuna manual medicine, 2017."},{"key":"2025123106454167000_15.8.e094099.7","first-page":"173","article-title":"A comparative study on the concepts of the Chuna (\u63a8\u62ff)","volume":"21","author":"Park","year":"2008","journal-title":"JKMC"},{"key":"2025123106454167000_15.8.e094099.8","doi-asserted-by":"crossref","first-page":"294","DOI":"10.3390\/healthcare10020294","article-title":"Safety of Chuna Manipulation Therapy in 289,953 Patients with Musculoskeletal Disorders: A Retrospective Study","volume":"10","author":"Kim","year":"2022","journal-title":"Healthcare (Basel)"},{"key":"2025123106454167000_15.8.e094099.9","doi-asserted-by":"crossref","first-page":"142","DOI":"10.56986\/pim.2023.10.002","article-title":"An Umbrella Review of Systematic Reviews for Chuna (or Tuina) Manual Therapy on Musculoskeletal Disorders","volume":"2","author":"Kim","year":"2023","journal-title":"PIM"},{"key":"2025123106454167000_15.8.e094099.10","doi-asserted-by":"crossref","DOI":"10.1155\/2017\/8218139","article-title":"Chuna (or Tuina) Manual Therapy for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"2017","author":"Lee","year":"2017","journal-title":"Evid Based Complement Alternat Med"},{"key":"2025123106454167000_15.8.e094099.11","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.13757","article-title":"Chuna Manual Therapy vs Usual Care for Patients With Nonspecific Chronic Neck Pain: A Randomized Clinical Trial","volume":"4","author":"Lee","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2025123106454167000_15.8.e094099.12","doi-asserted-by":"crossref","DOI":"10.1016\/j.imr.2021.100746","article-title":"The process of National Health Insurance coverage for Chuna Manual Therapy in Korea: A qualitative study","volume":"11","author":"Yu","year":"2022","journal-title":"Integr Med Res"},{"key":"2025123106454167000_15.8.e094099.13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.30581\/jcmm.2023.18.2.53","article-title":"Status of Chuna Manual Therapy Usage Before and After COVID-19 Social Distancing","volume":"18","author":"Lim","year":"2023","journal-title":"Korean Soc Chuna Man Medicine Spine Nerves"},{"key":"2025123106454167000_15.8.e094099.14","doi-asserted-by":"crossref","first-page":"61","DOI":"10.18325\/jkmr.2022.32.4.61","article-title":"Analysis of Chuna Manual Therapy Usage Status after the Application of Chuna Manual Therapy Health Insurance (2019-2021)","volume":"32","author":"Park","year":"2022","journal-title":"J Korean Med Rehabil"},{"key":"2025123106454167000_15.8.e094099.15","doi-asserted-by":"crossref","first-page":"188","DOI":"10.13048\/jkm.19034","article-title":"The Statistics Study on Patients visiting a Korean Medicine Hospital according to the Application of Chuna Therapy Health Insurance and Medical benefits","volume":"40","author":"Kim","year":"2019","journal-title":"J Korean Med"},{"key":"2025123106454167000_15.8.e094099.16","doi-asserted-by":"publisher","DOI":"10.12997\/jla.2022.11.2.103"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-094099","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T14:46:19Z","timestamp":1767192379000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-094099"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":16,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,8]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/bmjopen-2024-094099"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-094099","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]}}}