scholarly journals Impact of insurance type on outcomes in cardiac arrest patients from 2004 to 2015: A nation-wide population-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254622
Author(s):  
Si Jin Lee ◽  
Kap Su Han ◽  
Eui Jung Lee ◽  
Sung Woo Lee ◽  
Myung Ki ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Hospital Costs ◽  
Medical Aid ◽  
Insurance Type ◽  
Hospital Factors ◽  
One Year

Objectives There do not appear to be many studies which have examined the socio-economic burden and medical factors influencing the mortality and hospital costs incurred by patients with cardiac arrest in South Korea. We analyzed the differences in characteristics, medical factors, mortality, and costs between patients with national health insurance and those on a medical aid program. Methods We selected patients (≥20 years old) who experienced their first episode of cardiac arrest from 2004 to 2015 using data from the National Health Insurance Service database. We analyzed demographic characteristics, insurance type, urbanization of residential area, comorbidities, treatments, hospital costs, and mortality within 30 days and one year for each group. A multiple regression analysis was used to identify an association between insurance type and outcomes. Results Among the 487,442 patients with cardiac arrest, the medical aid group (13.3% of the total) had a higher proportion of females, rural residents, and patients treated in low-level hospitals. The patients in the medical aid group also reported a higher rate of non-shockable conditions; a high Charlson Comorbidity Index; and pre-existing comorbidities, such as hypertension, diabetes mellitus, and renal failure with a lower rate of providing a coronary angiography. The national health insurance group reported a lower one-year mortality rate (91.2%), compared to the medical aid group (94%), and a negative association with one-year mortality (Adjusted OR 0.74, 95% CI 0.71–0.76). While there was no significant difference in short-term costs between the two groups, the medical aid group reported lower long-term costs, despite a higher rate of readmission. Conclusions Medical aid coverage was an associated factor for one-year mortality, and may be the result of an insufficient delivery of long-term services as reflected by the lower long-term costs and higher readmission rates. There were differences of characteristics, comorbidities, medical and hospital factors and treatments in two groups. These differences in medical and hospital factors may display discrepancies by type of insurance in the delivery of services, especially in chronic healthcare services.

scholarly journals Association between Extracorporeal Membrane Oxygenation (ECMO) and Mortality in the Patients with Cardiac Arrest: A Nation-Wide Population-Based Study with Propensity Score Matched Analysis

2020 ◽  
Vol 9 (11) ◽  
pp. 3703
Author(s):  
Su Jin Kim ◽  
Kap Su Han ◽  
Eui Jung Lee ◽  
Si Jin Lee ◽  
Ji Sung Lee ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Health Insurance ◽  
Propensity Score ◽  
Extracorporeal Membrane Oxygenation ◽  
National Health Insurance ◽  
National Health ◽  
Hospital Costs ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
The Impact

We attempted to determine the impact of extracorporeal membrane oxygenation (ECMO) on short-term and long-term outcomes and find potential resource utilization differences between the ECMO and non-ECMO groups, using the National Health Insurance Service database. We selected adult patients (≥20 years old) with non-traumatic cardiac arrest from 2007 to 2015. Data on age, sex, insurance status, hospital volume, residential area urbanization, and pre-existing diseases were extracted from the database. A total of 1.5% (n = 3859) of 253,806 patients were categorized into the ECMO group. The ECMO-supported patients were more likely to be younger, men, more covered by national health insurance, and showed, higher usage of tertiary level and large volume hospitals, and a lower rate of pre-existing comorbidities, compared to the non-ECMO group. After propensity score-matching demographic data, hospital factors, and pre-existing diseases, the odds ratio (ORs) of the ECMO group were 0.76 (confidence interval, (CI) 0.68–0.85) for 30-day mortality and 0.66 (CI 0.58–0.79) for 1-year mortality using logistic regression. The index hospitalization was longer, and the 30-day and 1-year hospital costs were greater in the matched ECMO group. Although ECMO support needed longer hospitalization days and higher hospital costs, the ECMO support reduced the risk of 30-day and 1-year mortality compared to the non-ECMO patients.

scholarly journals 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

2020 ◽  
Author(s):  
Sun Mi Shin ◽  
Hee Woo Lee
Keyword(s):  
Health Insurance ◽  
Renal Disease ◽  
National Health Insurance ◽  
National Health ◽  
End Stage Renal Disease ◽  
Security System ◽  
Health Security ◽  
Medical Aid ◽  
Stage Renal Disease ◽  
End Stage

Abstract 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.

scholarly journals Relationship of Socioeconomic Status to Arterial Stiffness: Comparison Between Medical Aid Beneficiaries and National Health Insurance Beneficiaries

2020 ◽  
Vol 33 (8) ◽  
pp. 718-725
Author(s):  
Hack-Lyoung Kim ◽  
Jin Yong Lee ◽  
Woo-Hyun Lim ◽  
Jae-Bin Seo ◽  
Sang-Hyun Kim ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Health Insurance ◽  
Arterial Stiffness ◽  
National Health Insurance ◽  
National Health ◽  
Low Socioeconomic Status ◽  
Multivariable Analysis ◽  
Laboratory Findings ◽  
Low Socioeconomic ◽  
Medical Aid

Abstract Background There is no general agreement on underlying pathophysiology explaining the high burden of cardiovascular disease on people at low socioeconomic status (SES). This study was conducted to investigate the association between healthcare systems and arterial stiffness. Methods A total of 8,929 subjects (60 years old and 55% were male) who underwent brachial-ankle pulse wave velocity (baPWV) measurement were retrospectively analyzed. There were 8,237 National Health Insurance (NHI) beneficiaries (92.2%) and 692 medical aid (MA) beneficiaries (7.8%). The median value of baPWV was 1,540 cm/s. Results Subjects with higher baPWV values (≥1,540 cm/s) were older, and more frequently had cardiovascular risk factors and unfavorable laboratory findings than those with lower values baPWV (&lt;1,540 cm/s). The baPWV values were significantly higher in MA beneficiaries than in NHI beneficiaries (1,966 ± 495 vs. 1,582 ± 346 cm/s, P &lt; 0.001). The proportion of MA beneficiaries was significantly higher in subjects with higher baPWV than those with lower baPWV (13.1% vs. 2.3%, P &lt; 0.001). In multivariable analysis, MA beneficiaries were significantly associated with higher baPWV values even after controlling for potential confounders (odds ratio, 5.41; 95% confidence intervals, 4.02–7.27; P &lt; 0.001). Conclusions The baPWV values were significantly higher in MA beneficiaries than in NHI beneficiaries. The result of this study provides additional evidence on the association between low SES and arterial stiffening.

scholarly journals Thiazide diuretics and the risk of hip fracture after stroke: a population-based propensity-matched cohort study using Taiwan’s National Health Insurance Research Database

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016992 ◽  
Author(s):  
Shu-Man Lin ◽  
Shih-Hsien Yang ◽  
Hung-Yu Cheng ◽  
Chung-Chao Liang ◽  
Huei-Kai Huang
Keyword(s):  
Cohort Study ◽  
Health Insurance ◽  
Hip Fracture ◽  
National Health Insurance ◽  
National Health ◽  
Population Based ◽  
Research Database ◽  
Matched Cohort ◽  
Matched Cohort Study

ObjectivesThis study aimed to investigate the association between thiazide use and the risk of hip fracture after stroke.SettingA population-based, propensity-matched cohort study was conducted on the basis of Taiwan’s National Health Insurance Research Database.ParticipantsPatients with newly diagnosed ischaemic stroke between 2000 and 2011 were included. After propensity score matching, 7470 patients were included, of whom 3735 received thiazides and 3735 did not.Outcome measuresHRs for developing hip fractures within 2 years after stroke were calculated using Cox proportional hazards regression model with adjustments for sociodemographic and coexisting medical conditions.ResultsOverall, patients using thiazides after stroke had a lower risk of hip fracture than those not using thiazides (8.5 vs 13.9 per 1000 person-years, adjusted HR=0.64, 95% CI 0.46 to 0.89, p=0.007). Further sensitivity analysis based on the duration of thiazide use revealed that the risk of hip fracture tended to decrease as the duration of exposure of thiazides increased. However, the effect was significant only in patients with long-term use of thiazides (using thiazides for >365 days within 2 years after stroke), with a 59% reduction in the risk of hip fracture when compared with patients not using thiazide (adjusted HR=0.41, 95% CI 0.22 to 0.79, p=0.008).ConclusionsThe long-term use of thiazides is associated with a decreased risk of hip fracture after stroke.

scholarly journals Antibiotics prescription pattern and determinants of utilization in the national health insurance scheme at a Tertiary Hospital in Nigeria

2019 ◽  
Vol 19 (3) ◽  
pp. 2356-2364
Author(s):  
Roland Nnaemeka Okoro ◽  
Chijioke Nmeka ◽  
Patrick O Erah
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Tertiary Hospital ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Cross Sectional ◽  
Amoxicillin Clavulanate ◽  
One Year

Background: Subsidizing the cost of medicines through insurance schemes increases consumption of medicines and may contribute to irrational use of antibiotics. Objectives: To describe the systemic antibiotics prescriptions patterns and analyze the determinants of their utilization in the National Health insurance Scheme (NHIS).Methods: Established WHO guideline was followed to conduct this cross-sectional retrospective study at University of Nigeria Teaching Hospital, Nigeria. Data were collected from randomly sampled prescription sheets of one year duration. Logistic regression analysis was performed to determine the predictors of antibiotics prescriptions.Results: The results are based on 802 sampled out-patients NHIS prescriptions. Average number of medicines per encounter was 4.0 ± 1.8, whereas 46.9% of antibiotics were prescribed by generic name. Penicillins (most frequently amoxicillin/clavulanate), and nitroimidazole (most frequently metronidazole) were the most commonly prescribed antibiotics with percentage share of 43.3% and 22.2%. Being <5 years old, and taking more than 4 medicines (OR 2.20, 95% CI 1.37-3.55) were the factors associated with the highest risk of antibiotics exposure.Conclusion: There were poly-pharmacy, and non-adherence to generic antibiotic prescriptions. Penicillins (amoxicillin/clavulanate) were the most commonly prescribed antibiotic class. Being < 5 years old, and taking more than 4 medicines were significant predictors of antibiotics exposure.Keywords: Antibiotics; national health insurance scheme; Nigeria; poly-pharmacy; prescription.

scholarly journals Analysis of characteristics and trends of the In-Hospital Cardiac Arrest incidence in the Republic of Korea: clinical usefulness of national health insurance claim data

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Circulatory System ◽  
Claim Data ◽  
Republic Of Korea ◽  
Classification Of Diseases ◽  
The Republic ◽  
Hospital Cardiac Arrest

Backgrounds: In-Hospital Cardiac Arrest (IHCA) requires the preparation of considerable medical resources in hospitals. Furthermore, compared to Out-of-Hospital Cardiac Arrest, until recently, there have not been many studies on the incidence, characteristics, and prognosis of IHCA. This study is to examine IHCA event rates among hospitalized patients in the Republic of Korea from 2011 to 2015. Methods: The incidence of IHCA in adults was extracted from claim data of the National Health Insurance Service from 2011 to 2015, and analyzed according to age, sex, the classification under the 7th revision of the Korean Standard Classification of Diseases (KCD-7), hospital types, and provinces. Results: From 2011 to 2015, the overall incidence of IHCA in Korea was founded to be 3.00 per 1,000 hospitalizations. The overall 5-year IHCA incidence was higher in male at 3.92 cases per 1,000 hospitalizations and at female 2.19 cases per 1,000 hospitalizations. Incidence due to cardiovascular disease increased year by year, whereas incidences due to respiratory, neurological and infectious disease were decreasing, and in the case of oncologic disease, there was no change. In particular, patients with diseases of the circulatory system had at least a two times higher incidence compared to those with other diseases. The IHCA incidence in general hospitals and tertiary hospitals was at least two-fold higher than the national overall and showed an increasing trend. The provinces that showed a higher IHCA incidence than the five-year national overall were Jeju Special Self-Governing Province, Gangwon Province, and Seoul. Conclusions: The results of this study can be used as important basic data to secure patient safety by reducing the occurrence of IHCA.

scholarly journals Incidence and etiology of sudden cardiac arrest in Koreans: A cohort from the national health insurance service database

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242799
Author(s):  
Seung-Young Roh ◽  
Jong-Il Choi ◽  
Min Sun Kim ◽  
Eun Young Cho ◽  
Yun Gi Kim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Large Population ◽  
Sudden Cardiac Arrest ◽  
South Korean ◽  
Korean National Health Insurance ◽  
Artery Disease ◽  
Major Factors

The incidence of sudden cardiac arrest (SCA) in Asians is lower than that seen in Western populations, but there are few available data on the incidence and associated cardiac etiology of SCA in Asians. From 2002 to 2013, patients with SCA were analyzed using a cohort from the South Korean National Health Insurance Service (NHIS) coded database. Sudden unexplained death syndrome (SUDS) was defined as cryptogenic arrest, excluding that of non-cardiac origin, coronary artery disease (CAD), cardiomyopathy (CM), and valvular heart disease. During the 12-year study period, 5,973 patients (0.53%) from the total cohort of 1,125,691 had a cardiac arrest code. The overall incidence of arrest was 48.7 per 100,000 person-years (95% CI 16.6–18.0). The incidence of primary SCA excluding those of non-cardiac origin was 16.1 per 100,000 person-years (95% CI 15.4–16.8). It was higher in males than in females (18.1 vs. 14.1 per 100,000 person-years). CAD was the most common cause of SCA (59.4%), and followed by CM (13.9%). SUDS accounted for 14.7% of SCA events. The risk of SCA had increased gradually from over 25 years old. Heart failure, atrial fibrillation and hypertension are major factors associated with SCA incidence. Our findings outline epidemiologic data for SCA and the proportion of associated cardiac etiology leads SCA in a large population.

Abstract 11106: The Incidence of Sudden Cardiac Arrest Continues to Rise, but Outcome is at a Standstill in South Korea: Analyzed From National Health Insurance Database Cohort From 2003 to 2013

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Pil-sung Yang ◽  
Hancheol Lee ◽  
Tae-Hoon Kim ◽  
Jae-Sun Uhm ◽  
Hui-Nam Pak ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Health Insurance ◽  
South Korea ◽  
National Health Insurance ◽  
National Health ◽  
Sudden Cardiac Arrest ◽  
National Health Insurance Database ◽  
The Past ◽  
Health Insurance Database ◽  
Insurance Database

Introduction: Sudden cardiac arrest (SCA) is a major clinical and public health problem. South Korea is aging faster than any other country, and the disease spectrum has changed profoundly in the last few decades. The purpose of this study was to investigate the change of the incidence and outcome of SCA over the past ten years. Methods: With the use of the National Health Insurance Database Cohort (NHID-Cohort) consisting of one million patients from 2003 through 2013, we identified the patient with sudden cardiac arrest using Korean Standard Classification of Diseases, 6th Revision, code I46. Results: In all, 5,307 (0.52%) patients with SCA were identified between 2003 and 2013. SCA occurred more frequent in men (59.3%) than women (40.7%) (p<0.001). The annual incidence of SCA increased by 116.3% from 28.9 in 2003 to 62.5 in 2013 (per 100,000 person-year, p<0.001). The increase of SCA was particularly predominant in patients with ≥60 years of age (from 153.8 to 259.1 per 100,000 person-year, p<0.001) and those with low economic status (from 27.5 to 85.2 per 100,000 person-year, p<0.001). Health care cost per 100,000 person-year also increased from $65,866 in 2003 to $241,534 in 2013 (p<0.001). However, there was no significant improvement in one-month survival rate during the same period (11.9% in 2003, 13.4% in 2013, p=0.526). Conclusions: The incidence of SCA in South Korea continues to rise over the past ten years, especially in elderly people. Despite the tremendous advances in the field of cardiovascular medicine, outcome of SCA is at a standstill.

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