J Korean Med Sci.  2014 Dec;29(12):1590-1596. 10.3346/jkms.2014.29.12.1590.

Evidence of a Broken Healthcare Delivery System in Korea: Unnecessary Hospital Outpatient Utilization among Patients with a Single Chronic Disease Without Complications

• Lee JY
• Jo MW
• Yoo WS
• Kim HJ
• Eun SJ

• KMID: 2069945
• DOI: http://doi.org/10.3346/jkms.2014.29.12.1590

Abstract

This study aims to estimate the volume of unnecessarily utilized hospital outpatient services in Korea and quantify the total cost resulting from the inappropriate utilization. The analysis included a sample of 27,320,505 outpatient claims from the 2009 National Inpatient Sample database. Using the Charlson Comorbidity Index (CCI), patients were considered to have received 'unnecessary hospital outpatient utilization' if they had a CCI score of 0 and were concurrently admitted to hospital for treatment of a single chronic disease - hypertension (HTN), diabetes mellitus (DM), or hyperlipidemia (HL) - without complication. Overall, 85% of patients received unnecessary hospital services. Also hospitals were taking away 18.7% of HTN patients, 18.6% of DM and 31.6% of HL from clinics. Healthcare expenditures from unnecessary hospital outpatient utilization were estimated at: HTN (94,058 thousands USD, 38.6% of total expenditure); DM (17,795 thousands USD, 40.6%) and HL (62,876 thousands USD, 49.1%). If 100% of patients who received unnecessary hospital outpatient services were redirected to clinics, the estimated savings would be 104,226 thousands USD. This research proves that approximately 85% of hospital outpatient utilizations are unnecessary and that a significant amount of money is wasted on unnecessary healthcare services; thus burdening the National Health Insurance Service (NHIS) and patients.

Keyword

Primary Health Care; Costs and Cost Analysis; Utilization; Referral and Consultation

MeSH Terms

Chronic Disease/*economics/*epidemiology/therapy
Comorbidity
Delivery of Health Care/economics/utilization
Health Care Costs/*statistics & numerical data
Humans
Outpatient Clinics, Hospital/*economics/*utilization
Patient Admission/economics/statistics & numerical data
Prevalence
Republic of Korea/epidemiology
Unnecessary Procedures/*economics/*utilization
Utilization Review