Changes in the Number of Children and Adolescents with Complex Chronic Conditions and Medical Spending: Analyzing National Health Insurance Claims Data from 2011 to 2021

Abstract

Background:The number of children and adolescents has decreased by more than 3 million over the past 10 years. We analyzed changes in the number of children and adolescents with complex chronic conditions (CCCs) and their medical expenditures between 2011 and 2021. Methods: We used National Health Insurance claims data of patients under the age of 20 from 2011 to 2021. CCCs were classified as pediatric CCCs by Feudtner et al. Patients who repeatedly utilize medical services due to CCCs were defined as patients who sought medical care twice or more within the past 3 years. Their sex, age, CCC categories, and the number of CCC categories were presented using descriptive analyses. Results: The number of children and adolescents with CCCs increased from 345,320 (3.04%) in 2011 to 451,238 (5.33%) in 2021. Patients who repeatedly utilized medical services due to CCCs increased by 71,889 during the same period. The proportion of patients with two or more CCC categories increased from 35.80% in 2011 to 43.67% in 2021. In 2021, patients with other congenital or genetic defect were most common. Medical expenditures associated with CCCs increased from 475,654 million won (12.34%) in 2011 to 768,467 million won (19.11%) in 2021. Conclusion:The number of patients with CCCs and their medical expenditures increased in Korea between 2011 and 2021. The results indicate that consistent national efforts are required to maintain the specialized pediatric care. Further studies are needed to identify pediatric patients who require specialized medical services through various methods.