Comparison of medical outcomes and health care costs at the end of life between dialysis patients with and without cancer: a national population-based study

Chiang, Jui Kun; Chen, Jean Shi; Kao, Yee Hsin

doi:10.1186/s12882-019-1440-9

Cited by 10 publications

(10 citation statements)

References 47 publications

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“…Thus, subjects with a serious disease like ESRD with the NHI faced a much greater economic burden than those with MA. Subjects with high OOP expenditure are more likely to face the risk of CHI [25][26][27][28]. CHE was compared between subjects with MA (n=68) and…”

Section: Discussionmentioning

confidence: 99%

Comparison of Healthcare Utilization and Out-of-pocket Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

Shin¹

2020

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Background: Korea's health security system named National Health Insurance and Medical Aid has revolutionized the nation's mandatory health insurance and continues to reduce excessive copayments. However, few have been studied on healthcare utilization and expenditure according to the health security system in case of severe disease. This study looked at reverse discrimination within End-Stage Renal Disease between National Health Insurance and Medical Aid. Methods: Subjects were a total of 305 diagnosed with End-Stage Renal Disease in Korea Health Panel from 2008 to 2013. Chi-square, t-test, and ANCOVA were conducted to identify healthcare utilization rate, out-of-pocket expenditure, and catastrophic expenditure rate. Fixed effect panel analysis was used to evaluate total out-of-pocket expenditure over a 6-year trend by National Health Insurance and Medical Aid. Results: There were no significant differences in healthcare utilization rate in emergency-room visits, admission, or out-patient department visits between National Health Insurance and Medical Aid because healthcare service was essential for a serious disease such as End-Stage Renal Disease. Meanwhile, each out-of-pocket expenditure for admission and out-patient department in National Health Insurance was 2.6 and 3.1 times higher than Medical Aid (P<0.05). A total of out-of-pocket expenditure including emergency-room visits, admission, out-patient department visits, and prescribed drug expenditure was 2.9 times higher in National Health Insurance than those of Medical Aid (P<0.001). Over a 6-year trend for a total of out-of-pocket expenditure, subjects with National Health Insurance spent more than those of Medical Aid (P<0.01). If annual household gross income was less than the median and subjects were covered by National Health Insurance, the catastrophic health expenditure rate was 85.9%, but 47.1% in Medical Aid (P<0.001). Conclusion: Serious disease such as End-Stage Renal Disease can result in reverse discrimination depending on the type of health security system. It is necessary to consider those who belong to National Health Insurance but are still poor. Key words: National Health Insurance, Medical Aid, Healthcare utilization, Out-of-pocket expenditure, End-stage Renal Disease, Catastrophic health expenditure

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Section: Discussionmentioning

confidence: 99%

Comparison of Healthcare Utilization and Out-of-pocket Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

Shin¹

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Thus, subjects with a serious disease like ESRD with the NHI faced a much greater economic burden than those with MA. Furthermore, subjects with high OOP expenditure are more likely to face the risk of CHE [25][26][27][28]. CHE was compared between subjects with NHI under the median of household income decile and with MA.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Out-of-Pocket Expenditure and Catastrophic Health Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

Shin

Lee²

2020

Preprint

View full text Add to dashboard Cite

Background: Korea's health security system named National Health Insurance and Medical Aid has revolutionized the nation's mandatory health insurance and continues to reduce excessive copayments. However, few have been studied on healthcare utilization and expenditure according to the health security system in case of severe disease. This study looked at reverse discrimination within end-stage renal disease between National Health Insurance and Medical Aid. Methods: Subjects were a total of 305 diagnosed with end-stage renal disease in Korea Health Panel from 2008 to 2013. Chi-square, t-test, and ANCOVA were conducted to identify healthcare utilization rate, out-of-pocket expenditure, and prevalence of catastrophic expenditure. Mixed effect panel analysis was used to evaluate total out-of-pocket expenditure over a 6-year trend by National Health Insurance and Medical Aid. Results: There were no significant differences in healthcare utilization rate in emergency-room visits, admission, or out-patient department visits between National Health Insurance and Medical Aid because healthcare service was essential for a serious disease such as End-stage Renal Disease.Meanwhile, each out-of-pocket expenditure for admission and out-patient department in National Health Insurance was 2.6 and 3.1 times higher than Medical Aid (P<0.05). A total of out-of-pocket expenditure including emergency-room visits, admission, out-patient department visits, and prescribed drug expenditure was 2.9 times higher in National Health Insurance than those of Medical Aid (P<0.001). Over a 6-year trend for a total of out-of-pocket expenditure, subjects with National Health Insurance spent more than those of Medical Aid (P<0.01). If total household income decile was less than the median and subjects were covered by National Health Insurance, the catastrophic health expenditure rate was 92.2%, but 58.8% in Medical Aid (P<0.001). Conclusion: Serious disease such as end-stage renal disease can result in reverse discrimination depending on the type of health security system. It is necessary to consider those who belong to National Health Insurance but are still poor.

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“…Thus, subjects with a serious disease like ESRD with the NHI faced a much greater economic burden than those with MA. Subjects with high OOP expenditure are more likely to face the risk of CHE [25][26][27][28]. CHE was compared between subjects with NHI (n=68) under the median of household income decile and with MA (n=68).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Out-of-pocket Expenditure and Catastrophic Health Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

Shin

Lee²

2020

Preprint

View full text Add to dashboard Cite

Background: Korea's health security system named National Health Insurance and Medical Aid has revolutionized the nation's mandatory health insurance and continues to reduce excessive copayments. However, few have been studied on healthcare utilization and expenditure according to the health security system in case of severe disease. This study looked at reverse discrimination within End-stage Renal Disease between National Health Insurance and Medical Aid. Methods: Subjects were a total of 305 diagnosed with End-stage Renal Disease in Korea Health Panel from 2008 to 2013. Chi-square, t-test, and ANCOVA were conducted to identify healthcare utilization rate, out-of-pocket expenditure, and prevalence of catastrophic expenditure. Mixed effect panel analysis was used to evaluate total out-of-pocket expenditure over a 6-year trend by National Health Insurance and Medical Aid. Results: There were no significant differences in healthcare utilization rate in emergency-room visits, admission, or out-patient department visits between National Health Insurance and Medical Aid because healthcare service was essential for a serious disease such as End-stage Renal Disease. Meanwhile, each out-of-pocket expenditure for admission and out-patient department in National Health Insurance was 2.6 and 3.1 times higher than Medical Aid (P<0.05). A total of out-of-pocket expenditure including emergency-room visits, admission, out-patient department visits, and prescribed drug expenditure was 2.9 times higher in National Health Insurance than those of Medical Aid (P<0.001). Over a 6-year trend for a total of out-of-pocket expenditure, subjects with National Health Insurance spent more than those of Medical Aid (P<0.01). If total household income decile was less than the median and subjects were covered by National Health Insurance, the catastrophic health expenditure rate was 92.2%, but 58.8% in Medical Aid (P<0.001). Conclusion: Serious disease such as End-stage Renal Disease can result in reverse discrimination depending on the type of health security system. It is necessary to consider those who belong to National Health Insurance but are still poor.

show abstract

Comparison of medical outcomes and health care costs at the end of life between dialysis patients with and without cancer: a national population-based study

Cited by 10 publications

References 47 publications

Comparison of Healthcare Utilization and Out-of-pocket Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

Comparison of Healthcare Utilization and Out-of-pocket Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

Comparison of Out-of-Pocket Expenditure and Catastrophic Health Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

Comparison of Out-of-pocket Expenditure and Catastrophic Health Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

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