Acute Crit Care.  2022 Feb;37(1):53-60. 10.4266/acc.2021.01389.

Association between the National Health Insurance coverage benefit extension policy and clinical outcomes of ventilated patients: a retrospective study

Affiliations
  • 1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
  • 2Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea

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 5 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 U.S. dollars [USD], P<0.001), out-of-pocket (median, 5,932 vs. 4,081 USD; P<0.001), 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], 2.794; 95% confidence interval [CI], 1.980–3.941; 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. 27.7%, P<0.001). They were associated with higher in-hospital mortality (HR, 3.904; 95% CI, 2.533–6.039; 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.

Keyword

health expenditures; health insurance; mechanical ventilation; mortality

Figure

  • Figure 1. Flowchart of patient selection and clinical course.

  • Figure 2. Benefit items under the health insurance benefit extension policy and medical expenditure.aThe secondary poor is a class of people who are economically similar to or slightly better off than the poor. They are potentially poor, but cannot receive some benefits available to Medical Aid beneficiaries because their income exceeds the minimum cost of living due to their ability to work and they have some fixed property.

  • Figure 3. Kaplan-Meier curves of survival curves of in-hospital survival after intensive care unit admission according to the presence or absence of health insurance benefit items in total enrolled patients (Log-rank, 37.7; P<0.001) (A) and according to categorized as group A or B in patients with health insurance benefit items (Log-rank, 46.3; P<0.001) (B). Group A includes following benefit items: cancer, tuberculosis and disability. Group B includes following benefit items: long-term hospitalization, rarely incurable, secondary poor, secondary poor with disability, hemodialysis, and severely ill.


Cited by  1 articles

The effect of socioeconomic status, insurance status, and insurance coverage benefits on mortality in critically ill patients admitted to the intensive care unit
Moo Suk Park
Acute Crit Care. 2022;37(1):118-119.    doi: 10.4266/acc.2022.00129.


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