Yonsei Med J.  2019 Oct;60(10):976-983. 10.3349/ymj.2019.60.10.976.

Impacts of Financial Coverage on Long-Term Outcome of Intensive Care Unit Survivors in South Korea

• Cha JK
• Oh TK
• Song IA

• KMID: 2459151
• DOI: http://doi.org/10.3349/ymj.2019.60.10.976

Abstract

PURPOSE
The objective of this study was to investigate whether financial coverage by the national insurance system for patients with lower economic conditions can improve their 1-year mortality after intensive care unit (ICU) discharge.
MATERIALS AND METHODS
This study, conducted in a single tertiary hospital, used a retrospective cohort design to investigate discharged ICU survivors between January 2012 and December 2016. ICU survivors were classified into two groups according to the National Health Insurance (NHI) system in Korea: medical aid program (MAP) group, including people who have difficulty paying their insurance premium or receive medical aid from the government due to a poor economic status; and NHI group consisting of people who receive government subsidy for approximately 2/3 of their medical expenses.
RESULTS
After propensity score (PS) matching, a total of 2495 ICU survivors (1859 in NHI group and 636 in MAP group) were included in the analysis. Stratified Cox regression analysis of PS-matched cohorts showed that 1-year mortality was 1.31-fold higher in MAP group than in NHI group (hazard ratio: 1.31, 95% confidence interval, 1.06 to 1.61; p=0.012). According to Kaplan-Meir estimation, MAP group also showed significantly poorer survival probability than NHI group after PS matching (p=0.011).
CONCLUSION
This study showed that 1-year mortality was higher in ICU survivors with low economic status, even if financial coverage was provided by the government. Our result suggests the necessity of a more nuanced and multifaceted approach to policy for ICU survivors with low economic status.

Keyword

Critical care; intensive care units; insurance; mortality

MeSH Terms

Cohort Studies
Critical Care*
Financing, Government
Humans
Insurance
Intensive Care Units*
Korea*
Mortality
National Health Programs
Propensity Score
Retrospective Studies
Survivors
Tertiary Care Centers

Figure

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  Fig. 1 Flow chart depicting patient selection. ICU, intensive care unit.

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  Fig. 2 Kaplan-Meir curve of overall survival after intensive care unit (ICU) discharge before (A) and after (B) propensity score matching.

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