The Use of Complementary and Alternative Medicine in a General Population in South Korea: Results from a National Survey in 2006

Interest in the use of complementary and alternative medicine (CAM) is increasing worldwide, even as conventional medical science continues to make remarkable advances. Data from national surveys performed in various countries indicate that CAM therapies are popular (1-12) and that, consequently, the use and expenditures for CAM have risen substantially (13, 14) in recent years.

In 1999, the first national survey on CAM use among the general population in the Republic of Korea reported that 29% of the population, as determined by telephone interview, had used CAM within the preceding 12-month period (15). Although CAM use in South Korea has presumably increased at a considerable pace since then, no further national surveys have been conducted. Accordingly, the purpose of this survey was to obtain current information about the prevalence, costs, and patterns of CAM use in a general population in South Korea.

The increasing use of CAM therapies, as well as raised interests and rising costs, is a global phenomenon with a prevalence rate ranging from 15% to 76% (2, 4, 5, 7-14) in various countries. Our study suggests that about 75% of adults in the Republic of Korea had used some form of CAM in a 12-month period between 2005 and 2006, the median annual out of-pocket expenditures for which was KRW200,000 or about US$203.6. This prevalence rate is much higher than that reported in Western countries (2, 5, 8-12) and similar to that in Asian countries (4, 7). A comparison of our results with those of the previous national survey by Lee et al. (15) would appear to suggest that the prevalence of CAM use and the expenditures therefore are on the rise in South Korea. The prevalence of CAM use was 29% in 1999 (15) and about 75% in 2006. The mean annual out-of-pocket expenditure for CAM therapies was KRW72,750 or US$61 in 1999 (15) and KRW200,000 or $203 in 2006. However, these apparent increases may be explained by the different definitions of CAM use between the two surveys. Whereas our study looked at the use of CAM by all people regardless of medical condition, the prior study had limited its examination to CAM users who had also experienced symptoms or disease.

The higher prevalence of CAM use in South Korea, as compared to Western countries, may be related with KOM. Originally developed under the influence of Traditional Chinese Medicine (TCM), KOM ultimately evolved into a more Korean style of practice. Since the end of the 19th century, both KOM and conventional Western medicine were accepted as orthodox forms of medical care. Nevertheless, as Lee et al. suggested in their previous national study (15), and the present study also shows, KOM is now regarded as one of CAM therapies, possibly because TCM and modified versions of TCM in various countries are accepted around the world as a kind of CAM modality. This conceptualization of KOM is an important factor that increased the prevalence rate of CAM use shown in our study, similar to the rate of some Asian countries that regard TCM as conventional medicine (4, 7). Thus, it will be an important task to develop a consensus for the definition and taxonomy of CAM therapies in South Korea, as well as the rest of the world.

Our study found varying prevalence rates based on gender, demographic and socioeconomic factors, and health. By gender, CAM use was likely to be greater among women. With respect to demographic and socioeconomic factors, persons in the 50- to 59-yr age bracket, persons living in a metropolitan area, persons not employed, and persons with marital experience, religious beliefs, education level under high school, or higher level of family income were more likely to use CAM. Persons with medical problems and persons with lower self-perceptions of their general health status were also more likely to use CAM. Our prevalence of CAM use by people having medical problem was 87.3%. From the results of previous surveys, CAM usage rates of patients with chronic disease ranged from 33.2% to 84% (17-20), and the rates of cancer patients ranged from 41% to 72.7% (21-24) in South Korea . But because of the differences in the respective contents of these various surveys, it is hard to conclude that CAM usage rates of patients with chronic disease in 2006 rose in comparison to the rates previously reported. Still, with the exception of the educational factor, our results generally support those of previous reports from the West, which found that CAM use was more likely among persons with higher education (3, 5, 6, 8-10). Our results, on the other hand, differ somewhat from those of some Asian studies (4, 7).

There were various reported patterns of CAM therapy use according to the different nations. In our study, the biologically based therapies were the most commonly used, whereas mind-body therapies were not commonly used. But in the USA, mind-body therapies were found to be more popular than biologically based therapies (5), which may be related to cultural or religious differences.

Finally, this survey has limitations. First, there was an age limitation of the respondents. Because persons under 30 or over 70 yr of age were excluded, we could not obtain information about the usage patterns of CAM therapies from the very young and the elderly. Further surveys that include subjects under 30 or over 70 are needed. Secondly, multi-variate statistical analysis was not performed in our study, and further study for the factors on influencing the CAM use should be followed.

To protect the CAM users from unnecessary and unproven CAM therapies, the government, as well as the National Health Insurance Corporation and the various medical associations concerning CAM therapies in South Korea, must take greater interest in CAM therapies. First, financial support from the government is urgently needed in order to research CAM therapies to provide evidence of their safety, efficacy and cost-effectiveness. For example, even though 60.2% of South Koreans use dietary supplements, almost without prescription and irrespective of concurrent use with other pharmaceuticals, little information exists about these supplements. A WHO study reported that such trends raise concerns over the quality of the CAM products used, their therapeutic appropriateness for a given condition and the lack of medical follow-up (25). As such, the government should provide information about the benefits and risks of CAM therapies, such as the interaction between commonly used dietary supplements and prescribed conventional western drugs, and develop guidelines for use. This would also raise awareness among the orthodox medical community, which at present is largely uninterested in CAM therapies and skeptical of their benefits, so that complementary and alternative treatment modalities may be used more often, more effectively, and more safely in conjunction with the other standard forms of treatment available to patients.