Glossary

The official documentation and variable labels are written in Korean administrative language. This page gives the English translations used on this site, so that the same Korean term is always translated the same way.

Enrollment and premiums

한글	English	Notes
국민건강보험공단	National Health Insurance Service (NHIS)	The single public insurer
건강보험심사평가원	Health Insurance Review and Assessment Service (HIRA)	Reviews claims
자격	Eligibility	Enrollment status in a given year
가입자	Insured person
직장가입자	Employee insured	Wage workers and owners of businesses with at least one employee
지역가입자	Self-employed insured	Everyone not covered through an employer or as a dependent
세대주	Head of household	Used for self-employed insured and Medical Aid
세대원	Household member	Used for self-employed insured and Medical Aid
피부양자	Dependent	Family member covered through an employee insured
보험료	Premium	Contribution
보험료분위	Premium decile	Common proxy for income
의료급여	Medical Aid	Tax-financed coverage for low-income households
장애등급	Disability grade	Six grades until July 2019

Claims

한글	English	Notes
명세서	Claim	One billing record from a provider
진료내역	Treatment details	Line items on a claim
상병	Diagnosis
주상병	Primary diagnosis
부상병	Secondary diagnosis
의증	Suspected diagnosis	Includes rule-out diagnoses
처방전	Prescription
처방전교부상세	Prescription details	Drugs prescribed for dispensing at a pharmacy
요양기관	Provider	Hospitals, clinics, and pharmacies
요양개시일자	Start date of care
요양일수	Days of care
입내원일수	Days of visits or inpatient days
서식	Claim form	Distinguishes inpatient, outpatient, dental, and other claims
입원	Inpatient
외래	Outpatient
심사	Review	Claims review by HIRA
심결	Review decision	Amounts after review
요양급여비용총액	Total covered cost
본인부담금	Patient cost sharing
보험자부담금	Insurer payment
급여	Covered services
비급여	Non-covered services	Not in the claims data
산정특례	Special co-payment reduction	For cancer and other serious conditions
배제상병	Excluded diagnosis	Considered and then ruled out once the final diagnosis is confirmed
민감상병	Sensitive diagnosis	Masked in the sample databases
공단 특수상병	NHIS special diagnosis	Part of the sensitive diagnosis list
법정감염병	Notifiable infectious disease	Part of the sensitive diagnosis list
일당수가	Per diem payment
포괄수가제	Diagnosis-related group payment
본인부담상한제	Out-of-pocket ceiling

Screening and other records

한글	English	Notes
국가건강검진	National health screening
일반건강검진	General health screening
암검진	Cancer screening
영유아건강검진	Infant and child health screening
생애전환기 건강진단	Life-transition health screening	At ages 40 and 66, merged into general screening in 2018
구강검진	Oral health screening
사망	Death
노인장기요양보험	Long-term care insurance	Since July 2008
반출 심사	Export review	Review of results before they leave the analysis environment
표본연구DB	Sample research database
맞춤형연구DB	Customized research database
표본구분, 표본형태 구분	Sample type	Distinguishes the main sample from supplementary or refreshment samples
신규대상자	Refreshment member	Added to the Senior Cohort after 2008
균등화	Equivalized	Divided by the square root of household size
장기요양등급	Long-term care grade
국가데이터처	National statistics agency	Formerly Statistics Korea (통계청)
한국표준질병사인분류 (KCD)	Korean Classification of Diseases	Korean adaptation of ICD-10