Yonsei Med J.  2015 May;56(3):853-861. 10.3349/ymj.2015.56.3.853.

Mortality, Length of Stay, and Inpatient Charges for Heart Failure Patients at Public versus Private Hospitals in South Korea

• Kim SJ
• Park EC
• Kim TH
• Yoo JW
• Lee SG

• KMID: 2450364
• DOI: http://doi.org/10.3349/ymj.2015.56.3.853

Abstract

PURPOSE
This study compared in-hospital mortality within 30 days of admission, lengths of stay, and inpatient charges among patients with heart failure admitted to public and private hospitals in South Korea.
MATERIALS AND METHODS
We obtained health insurance claims data for all heart failure inpatients nationwide between November 1, 2011 and May 31, 2012. These data were then matched with hospital-level data, and multi-level regression models were examined. A total of 8406 patients from 253 hospitals, including 31 public hospitals, were analyzed.
RESULTS
The in-hospital mortality rate within 30 days of admission was 0.92% greater and the mean length of stay was 1.94 days longer at public hospitals than at private hospitals (mortality: 5.18% and 4.26%, respectively; LOS: 12.08 and 10.14 days, respectively). The inpatient charges were 11.4% lower per case and 24.5% lower per day at public hospitals than at private hospitals. After adjusting for patient- and hospital-level confounders, public hospitals had a 1.62-fold higher in-hospital mortality rate, a 16.5% longer length of stay, and an 11.7% higher inpatient charge per case than private hospitals, although the charges of private hospitals were greater in univariate analysis.
CONCLUSION
We recommend that government agencies and policy makers continue to monitor quality of care, lengths of stay in the hospital, and expenditures according to type of hospital ownership to improve healthcare outcomes and reduce spending.

Keyword

Public hospitals; mortality; fees and charges; length of stay

MeSH Terms

Aged
Female
Heart Failure/economics/*mortality/therapy
Hospital Charges/*statistics & numerical data
Hospital Mortality
Hospitalization/economics
Hospitals, Private/*economics
Hospitals, Public/*economics
Humans
Inpatients/*statistics & numerical data
Length of Stay/economics/*statistics & numerical data
Logistic Models
Male
Middle Aged
Multivariate Analysis
Outcome Assessment (Health Care)/economics
Patient Discharge/economics/statistics & numerical data
Republic of Korea/epidemiology
Survival Analysis
Time Factors

Figure

• 

  Fig. 1 The difference of outcome variables between public vs. private hospitals. Data is shown as mean±SD. *Significant (p<0.001).

Reference

1. Thomas EJ, Orav EJ, Brennan TA. Hospital ownership and preventable adverse events. J Gen Intern Med. 2000; 15:211–219.

2. Hirth RA. Consumer information and competition between nonprofit and for-profit nursing homes. J Health Econ. 1999; 18:219–240.

3. Tiemann O, Schreyögg J, Busse R. Hospital ownership and efficiency: a review of studies with particular focus on Germany. Health Policy. 2012; 104:163–171.

4. Eggleston K, Shen YC, Lau J, Schmid CH, Chan J. Hospital ownership and quality of care: what explains the different results in the literature? Health Econ. 2008; 17:1345–1362.

5. Fidler AH. The role of the private sector in health financing and service delivery. Eur J Public Health. 2009; 19:450–451.

6. Hasan MM. Let’s end the nonprofit charade. N Engl J Med. 1996; 334:1055–1057.

7. Travis P, Cassels A. Safe in their hands? Engaging private providers in the quest for public health goals. Bull World Health Organ. 2006; 84:427.

8. Hanson K, Gilson L, Goodman C, Mills A, Smith R, Feachem R, et al. Is private health care the answer to the health problems of the world’s poor? PLoS Med. 2008; 5:e233.

9. Preker AS, Harding A, Travis P. “Make or buy” decisions in the production of health care goods and services: new insights from institutional economics and organizational theory. Bull World Health Organ. 2000; 78:779–790.

10. Herr A. Cost and technical efficiency of German hospitals: does ownership matter? Health Econ. 2008; 17:1057–1071.

11. Hollingsworth B. The measurement of efficiency and productivity of health care delivery. Health Econ. 2008; 17:1107–1128.

12. Farsi M, Filippini M. Effects of ownership, subsidization and teaching activities on hospital costs in Switzerland. Health Econ. 2008; 17:335–350.

13. Dubois RW, Rogers WH, Moxley JH 3rd, Draper D, Brook RH. Hospital inpatient mortality. Is it a predictor of quality? N Engl J Med. 1987; 317:1674–1680.

14. Hartz AJ, Krakauer H, Kuhn EM, Young M, Jacobsen SJ, Gay G, et al. Hospital characteristics and mortality rates. N Engl J Med. 1989; 321:1720–1725.

15. Reinhardt UE. The economics of for-profit and not-for-profit hospitals. Health Aff (Millwood). 2000; 19:178–186.

16. Woolhandler S, Himmelstein DU. Costs of care and administration at for-profit and other hospitals in the United States. N Engl J Med. 1997; 336:769–774.

17. Arrow KJ. Uncertainty and the welfare economics of medical care. The Am Econ Rev. 1963; 53:941–973.

18. Rosenau PV, Linder SH. Two decades of research comparing for-profit and nonprofit health provider performance in the United States. Soc Sci Q. 2003; 84:219–241.

19. Devereaux PJ, Schunemann HJ, Ravindran N, Bhandari M, Garg AX, Choi PT, et al. Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers: a systematic review and meta-analysis. JAMA. 2002; 288:2449–2457.

20. Rosenau PV, Linder SH. A comparison of the performance of for-profit and nonprofit U.S. psychiatric inpatient care providers since 1980. Psychiatr Serv. 2003; 54:183–187.

21. Nawal Lutfiyya M, Bhat DK, Gandhi SR, Nguyen C, Weidenbacher-Hoper VL, Lipsky MS. A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States. Int J Qual Health Care. 2007; 19:141–149.

22. Browne J, Jamieson L, Lewsey J, van der, Copley L, Black N. Case-mix & patients’ reports of outcome in Independent Sector Treatment Centres: comparison with NHS providers. BMC Health Serv Res. 2008; 8:78.

23. Street A, Sivey P, Mason A, Miraldo M, Siciliani L. Are English treatment centres treating less complex patients? Health Policy. 2010; 94:150–157.

24. Helmig B, Lapsley I. On the efficiency of public, welfare and private hospitals in Germany over time: a sectoral data envelopment analysis study. Health Serv Manage Res. 2001; 14:263–274.

25. Oh JH. Modernization of public district general hospitals. Seoul: KDI School of Public Policy and Management;2012.

26. Lee JC. Health Care Reform in South Korea: Success or Failure? Am J Public Health. 2003; 93:48–51.

27. Korean Hospital Association. Hospital Management Statistics. 2012.

28. Yang BM. The role of health insurance in the growth of the private health sector in Korea. Int J Health Plann Manage. 1996; 11:231–252.

29. Kwon S. Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage. Health Policy Plan. 2009; 24:63–71.

30. Jeong HS. Korea’s National Health Insurance--lessons from the past three decades. Health Aff (Millwood). 2011; 30:136–144.

31. Park EC, Jang SI. The diagnosis of healthcare policy problems in Korea. J Korean Med Assoc. 2012; 55:932–939.

32. Cho WH, Chung KH, Kang IO. A study on the trend in the length of hospital stay in Korea. Korean J Prev Med. 1996; 29:51–66.

33. Hensen P, Beissert S, Bruckner-Tuderman L, Luger TA, Roeder N, Muller ML. Introduction of diagnosis-related groups in Germany: evaluation of impact on in-patient care in a dermatological setting. Eur J Public Health. 2008; 18:85–91.

34. Kim SJ, Park EC, Jang SI, Lee M, Kim TH. An analysis of the inpatient charge and length of stay for patients with joint diseases in Korea: specialty versus small general hospitals. Health Policy. 2013; 113:93–99.

35. Kim SJ, Park EC, Yoo KB, Kwon JA, Kim TH. The Association of Market Competition With Hospital Charges, Length of Stay, and Quality Outcomes for Patients With Joint Diseases: A Longitudinal Study in Korea. Asia Pac J Public Health. 2014; 04. 14. [Epub]. http://dx.doi.org/10.1177/1010539514529812.

36. Cho W, Lee S, Kang HY, Kang M. Setting national priorities for quality assessment of health care services in Korea. Int J Qual Health Care. 2005; 17:157–165.

37. Lee S, Choi KS, Kang HY, Cho W, Chae YM. Assessing the factors influencing continuous quality improvement implementation: experience in Korean hospitals. Int J Qual Health Care. 2002; 14:383–391.

38. Perelman J, Closon MC. Impact of socioeconomic factors on in-patient length of stay and their consequences in per case hospital payment systems. J Health Serv Res Policy. 2011; 16:197–202.

39. Epstein AM, Stern RS, Weissman JS. Do the poor cost more? A multihospital study of patients’ socioeconomic status and use of hospital resources. N Engl J Med. 1990; 322:1122–1128.

40. Siciliani L, Sivey P, Street A. Differences in length of stay for hip replacement between public hospitals, specialised treatment centres and private providers: selection or efficiency? Health Econ. 2013; 22:234–242.

41. OECD. OECD Health Data 2012. accessed on 2015 March 6. Available at: http://www.oecd.org/health/healthdata.

42. Song YJ. The South Korean Health Care System. JMAJ. 2009; 52:206–209.