Association between the National Health Insurance coverage benefit extension policy and clinical outcomes of ventilated patients: a retrospective study
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Background: This study aimed to investigate the association between the Korean national health insurance coverage benefit extension policy and clinical outcomes of patients who were ventilated owing to various respiratory diseases.Methods: Data from 515 patients (male, 69.7%; mean age, 69.8±12.1 years; in-hospital mortality rate, 28.3%) who were hospitalized in a respiratory intensive care unit were retrospectively analyzed over five years.Results: Of total enrolled patients, 356 (69.1%) had one benefit items under this policy during their hospital stay. They had significantly higher medical expenditure (total: median, 23,683 vs. 12,742 USD, P<0.001), out-of-pocket (median, 5,932 vs. 4,081 USD; P=0.008), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (median, 26.0% vs. 32.2%; P<0.001). Patients without benefit items associated with higher in-hospital mortality (hazard ratio [HR], 2.825; 95% confidence interval [CI], 1.995–4.000; P<0.001). In analysis of patients with benefit items, patients with three items (“cancer”, “tuberculosis,” and “disability”) had significantly lower out-of-pocket medical expenditure (3,441 vs. 6,517 USD, P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (17.2% vs. 27.8%, P<0.001). They were associated with higher in-hospital mortality (HR, 3.996; 95% CI, 2.535–6.295, P<0.001).Conclusions: Our study showed patients with benefit items had more medical resources and associated improved in-hospital survival. Patients with the aforementioned three benefit items had lower out-of-pocket medical expenditure due to the implementation of this policy, but higher in-hospital mortality.
Abstract
Background: This study aimed to investigate the association between the Korean national health insurance coverage benefit extension policy and clinical outcomes of patients who were ventilated owing to various respiratory diseases.Methods: Data from 515 patients (male, 69.7%; mean age, 69.8±12.1 years; in-hospital mortality rate, 28.3%) who were hospitalized in a respiratory intensive care unit were retrospectively analyzed over five years.Results: Of total enrolled patients, 356 (69.1%) had one benefit items under this policy during their hospital stay. They had significantly higher medical expenditure (total: median, 23,683 vs. 12,742 USD, P<0.001), out-of-pocket (median, 5,932 vs. 4,081 USD; P=0.008), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (median, 26.0% vs. 32.2%; P<0.001). Patients without benefit items associated with higher in-hospital mortality (hazard ratio [HR], 2.825; 95% confidence interval [CI], 1.995–4.000; P<0.001). In analysis of patients with benefit items, patients with three items (“cancer”, “tuberculosis,” and “disability”) had significantly lower out-of-pocket medical expenditure (3,441 vs. 6,517 USD, P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (17.2% vs. 27.8%, P<0.001). They were associated with higher in-hospital mortality (HR, 3.996; 95% CI, 2.535–6.295, P<0.001).Conclusions: Our study showed patients with benefit items had more medical resources and associated improved in-hospital survival. Patients with the aforementioned three benefit items had lower out-of-pocket medical expenditure due to the implementation of this policy, but higher in-hospital mortality.
참고문헌 (11)
- "Social security system in Korea" (2021)[URL]
- Lee WY, "The impact of out-of-pocket payments on health care inequity : the case of National Health Insurance in South Korea", Int J Environ Res Public Health, 11, pp.7304~7318 (2014)
- 김지애, "Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data", Journal of Korean Medical Science, 32(5), pp.718~728 (2017), 대한의학회
- An J, "Medical cost trends under national health insurance benefit extension in Republic of Korea", Int J Health Plann Manage, 35, pp.1351~1370 (2020)
- Acute Respiratory Distress Syndrome Network; Brower RG, "Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome", N Engl J Med, 342, pp.1301~1308 (2000)
- Bahk J, "Trends in life expectancy among medical aid beneficiaries and National Health Insurance beneficiaries in Korea between 2004 and 2017", BMC Public Health, 19(1), pp.1137~ (2019)
- "Welfare services at a glance" (2021)[URL]
- Knaus WA, "APACHE II : a severity of disease classification system", Crit Care Med, 13, pp.818~829 (1985)
- Vincent JL, "The SOFA(Sepsis-related Organ Failure Assessment)score to describe organ dysfunction", failure : on behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine, 1996, pp.22, 707~710
- Charlson ME, "A new method of classifying10 prognostic comorbidity in longitudinal studies : development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- Kutzin J, "Health systems strengthening, universal health coverage, health security and resilience", Bull World Health Organ, 94, pp.2~ (2016)