{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:53:39Z","timestamp":1791899619817,"version":"4.3.4"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002551","name":"Seoul National University","doi-asserted-by":"publisher","award":["Startup Fund"],"award-info":[{"award-number":["Startup Fund"]}],"id":[{"id":"10.13039\/501100002551","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["HC15C1320"],"award-info":[{"award-number":["HC15C1320"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The demand for treating degenerative lumbar spinal disease has been increasing, leading to increased utilization of medical resources. Thus, we need to understand how the budget of insurance is currently used. The objective of the present study is to overview the utilization of the National Health Insurance Service (NHIS) by providing the direct insured cost between patients receiving surgery and patients receiving nonsurgical treatment for degenerative lumbar disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The NHIS-National Sample Cohort was utilized to select patients with lumbar disc herniation, spinal stenosis, spondylolisthesis or spondylolysis. A matched cohort study design was used to show direct medical costs of surgery (n = 2,698) and nonsurgical (n = 2,698) cohorts. Non-surgical treatment included medication, physiotherapy, injection, and chiropractic. The monthly costs of the surgery cohort and nonsurgical cohort were presented at initial treatment, posttreatment 1, 3, 6, 9, and 12 months and yearly thereafter for 10 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The characteristics and matching factors were well-balanced between the matched cohorts. Overall, surgery cohort spent $50.84\/patient\/month, while the nonsurgical cohort spent $29.34\/patient\/month (p&lt;0.01). Initially, surgery treatment led to more charge to NHIS ($2,762) than nonsurgical treatment ($180.4) (p&lt;0.01). Compared with the non-surgical cohort, the surgery cohort charged $33\/month more for the first 3 months, charged less at 12 months, and charged approximately the same over the course of 10 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Surgical treatment initially led to more government reimbursement than nonsurgical treatment, but the charges during follow-up period were not different. The results of the present study should be interpreted in light of the costs of medical services, indirect costs, societal cost, quality of life and societal willingness to pay in each country. The monetary figures are implied to be actual economic costs but those in the reimbursement system instead reflect reimbursement charges from the government.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0260460","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T16:03:30Z","timestamp":1638374610000},"page":"e0260460","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: A nationwide matched cohort study with a 10-year follow-up"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0497-1130","authenticated-orcid":true,"given":"Chi Heon","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun Kee","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunhee","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juhee","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Heon","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Hyun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Bae","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoung-Tae","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Rhee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moon Soo","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,12,1]]},"reference":[{"issue":"1","key":"pone.0260460.ref001","doi-asserted-by":"crossref","first-page":"66","DOI":"10.14245\/ns.1836038.019","article-title":"Health Care Burden of Spinal Diseases in the Republic of Korea: Analysis of a Nationwide Database From 2012 Through 2016","volume":"15","author":"CH Lee","year":"2018","journal-title":"Neurospine"},{"issue":"7","key":"pone.0260460.ref002","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1097\/00007632-199804010-00015","article-title":"5-year reoperation rates after different types of lumbar spine surgery","volume":"23","author":"AD Malter","year":"1998","journal-title":"Spine (Phila Pa 1976)"},{"issue":"5","key":"pone.0260460.ref003","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1097\/BRS.0000000000002822","article-title":"Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States, 2004 to 2015","volume":"44","author":"BI Martin","year":"2019","journal-title":"Spine (Phila Pa 1976)"},{"issue":"12","key":"pone.0260460.ref004","doi-asserted-by":"crossref","first-page":"2838","DOI":"10.1007\/s11999-017-5229-5","article-title":"Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?","volume":"475","author":"AJ Schoenfeld","year":"2017","journal-title":"Clin Orthop Relat Res"},{"issue":"7","key":"pone.0260460.ref005","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1016\/j.spinee.2013.08.018","article-title":"How do coverage policies influence practice patterns, safety, and cost of initial lumbar fusion surgery? 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