The Economic Burden of Stroke Based on South Korea’s National Health Insurance Claims Database

Document Type : Original Article


Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea


This study was conducted to determine the scale and the nature of the economic burden caused by strokes and to use the results as an evidential source for determining the allocation of South Korea stroke cases in 2015.

For research subjects, the study analyzed demographic characteristics and economic burden based on data from national health insurance (NHI) claims for inpatient and outpatient cases of ischemic stroke and hemorrhagic stroke in 2015 through the Health Insurance Review and Assessment Service (HIRA) and statistical data regarding cause of death from the Korea National Statistical Office (KNSO). This study, in order to estimate economic burden due to stroke, deduced the direct and indirect costs of illness caused by stroke, using cost-of-illness (COI) methods. The economic burden is divided into direct and indirect costs, and indirect cost is estimated by summing lost productivity measured in opportunity cost lost by medical disposition due to a specific disease and lost productivity due to premature death.
The total economic burden in Korea due to stroke was US$6.855 billion, that due to ischemic stroke was US$3.658 billion, and that due to hemorrhagic stroke was US$3.197 billion. The average economic burden per stroke case was about US$7247.

The results of estimating the annual economic burden in all of Korea due to stroke will be used as an evidential source for preparing medical insurance policies, priorities, and plans for arranging medical resources for stroke as well as for determining effective prevention of the disease and related priorities in national health care policies.


Supplementary File 1 (Download)

Supplementary File 2 (Download)


Main Subjects

  1. Lim SJ, Kim HJ, Nam CM, et al. [Socioeconomic costs of stroke in Korea: estimated from the Korea national health insurance claims database]. J Prev Med Public Health. 2009;42(4):251-260. doi:10.3961/jpmph.2009.42.4.251
  2. Skilbeck CE, Wade DT, Hewer RL, Wood VA. Recovery after stroke. J Neurol Neurosurg Psychiatry. 1983;46(1):5-8.
  3. Anderson CS, Linto J, Stewart-Wynne EG. A population-based assessment of the impact and burden of caregiving for long-term stroke survivors. Stroke. 1995;26(5):843-849.
  4. Brown ML, Lipscomb J, Snyder C. The burden of illness of cancer: economic cost and quality of life. Annu Rev Public Health. 2001;22:91-113. doi:10.1146/annurev.publhealth.22.1.91
  5. Joo H, George MG, Fang J, Wang G. A literature review of indirect costs associated with stroke. J Stroke Cerebrovasc Dis. 2014;23(7):1753-1763. doi:10.1016/j.jstrokecerebrovasdis.2014.02.017
  6. Fattore G, Torbica A, Susi A, et al. The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study. BMC Neurol. 2012;12:137. doi:10.1186/1471-2377-12-137
  7. Jin HJ, Cho SM. Estimation of socio-economic costs of illness due to blood concentration of heavy metals in Koreans among the public. Health Social Welfare Review. 2016;36(4):508-536. doi:10.15709/hswr.2016.36.4.508
  8. Kim J, Lee E, Lee T, Sohn A. Economic burden of acute coronary syndrome in South Korea: a national survey. BMC Cardiovasc Disord. 2013;13:55. doi:10.1186/1471-2261-13-55
  9. Turpie AG. Burden of disease: medical and economic impact of acute coronary syndromes. Am J Manag Care. 2006;12(16 Suppl):S430-434.
  10. Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. New York: Oxford University Press; 2015.
  11. Schmid A, Pugin J, Chevrolet JC, et al. Burden of illness imposed by severe sepsis in Switzerland. Swiss Med Wkly. 2004;134(7-8):97-102. doi:2004/07/smw-10475
  12. Kim HJ. The economic burden of stroke and continuity of care, medical costs & health outcomes of hypertension. Seoul: Public Health, Korea University; 2013.
  13. Jung YH, Ko SJ. Estimating socioeconomic cost of five major diseases. Korean J Public Finance 2004;18(2):77–104.
  14. Kim NK, Lee DH, Jo GW, Seo ES. A study about the Life Expectancy, Quality of Life and QALYs of Stroke patients. Korean journal of oriental preventive medical society. 2012;16(3):15-26.
  15. Kang HJ. Current state and challenges of National Health Insurance. Health Welf Policy Forum. 2016;231(1):15-30.
  16. Sundstrom G. Care by Families : An Overview of Trends. Caring for Frail Elderly People : New Directions in Care. Paris: Organisation of Economic Co-operation and Development; 1994.
  17. Kim EJ. A study on the utilization of health care resources and costs during the first year after a stroke. Seoul: Health Policy and Management, Korea University; 2004.
  18. Kang EJ, J KD, Sun WD, Yoon SS. Development of health care system for the elderly with medical expenditure analysis: Focusing on the reasonable medical care utilization of the stroke elderly. Sejong: Korea Institute for Health and Social Affairs; 2006.
  19. Barrett-Connor E. The economic and human costs of osteoporotic fracture. Am J Med. 1995;98(2a):3s-8s.
  20. Chang KC, Tseng MC. Costs of acute care of first-ever ischemic stroke in Taiwan. Stroke. 2003;34(11):e219-221. doi:10.1161/01.str.0000095565.12945.18
  21. Yoo SD, Jeong YS, Kim TW. Medical rehabilitation system for patients in acute rehabilitation units. J Korean Med Assoc. 2017;60(11):864-869.  doi:10.5124/jkma.2017.60.11.864
  22. Zhai S, Gardiner F, Neeman T, Jones B, Gawarikar Y. The Cost-Effectiveness of a Stroke Unit in Providing Enhanced Patient Outcomes in an Australian Teaching Hospital. J Stroke Cerebrovasc Dis. 2017;26(10):2362-2368. doi:10.1016/j.jstrokecerebrovasdis.2017.05.025
  23. Langhorne P, Holmqvist LW. Early supported discharge after stroke. J Rehabil Med. 2007;39(2):103-108. doi:10.2340/16501977-0042
  24. Mas MA, Inzitari M. A critical review of Early Supported Discharge for stroke patients: from evidence to implementation into practice. Int J Stroke. 2015;10(1):7-12. doi:10.1111/j.1747-4949.2012.00950.x
  25. Dewey HM, Thrift AG, Mihalopoulos C, et al. Cost of stroke in Australia from a societal perspective: results from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke. 2001;32(10):2409-2416. 
  26. Lee J, Lee JS, Park SH, Shin SA, Kim K. Cohort Profile: The National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Int J Epidemiol. 2017;46(2):e15. doi:10.1093/ije/dyv319
  • Receive Date: 28 October 2017
  • Revise Date: 20 April 2018
  • Accept Date: 21 April 2018
  • First Publish Date: 01 October 2018