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

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.

The effect of socioeconomic status, insurance status, and insurance coverage benefits on mortality in critically ill patients admitted to the intensive care unit

“…In Yoo et al’s study [ 11 ], the authors performed a single tertiary hospital cohort study that enrolled a total of 515 patients admitted to ICU over 5 years and showed that patients with NHI and additional benefit items experienced greater use of medical resources and improved in-hospital survival. Patients with the three benefit items “cancer,” “tuberculosis,” and “disability” had lower out-of-pocket medical expenditures due to the implementation of this policy but a higher in-hospital mortality rate [ 11 ].…”

“…In Yoo et al’s study [ 11 ], the authors performed a single tertiary hospital cohort study that enrolled a total of 515 patients admitted to ICU over 5 years and showed that patients with NHI and additional benefit items experienced greater use of medical resources and improved in-hospital survival. Patients with the three benefit items “cancer,” “tuberculosis,” and “disability” had lower out-of-pocket medical expenditures due to the implementation of this policy but a higher in-hospital mortality rate [ 11 ]. These authors concluded that the Korean NHI benefit extension policy was associated with reduced in-hospital mortality of NHI beneficiaries requiring ventilator care, although the limited nature of a single-center retrospective cohort study requires that ICU care policies be derived from future, larger studies relying on a multicenter database or a big data analysis using Health Insurance Review and Assessment Service or NHI service data.…”