Health Policy Manag.  2020 Sep;30(3):418-429. 10.4332/KJHPA.2020.30.3.418.

Multilevel Analysis of Factors Related to Cost and Length of Stay in Acute Myocardial Infarction Patients with Coronary Stenting: Based on Korean National Health Insurance Service’s Customized Database in 2010 and 2015

• Choi B
• Lee HJ

• KMID: 2507311
• DOI: http://doi.org/10.4332/KJHPA.2020.30.3.418

Abstract

Background
This study aims to analyze the cost and the length of stay (LOS) of acute myocardial infarction (AMI) patients with coronary artery stenting according to the characteristics of individuals and institutions.
Methods
The data was collected from Korean National Health Insurance Service’s customized database in 2010 and 2015. Chi-square test, t-test, analysis of variance, and multilevel analysis were performed.
Results
The intraclass correlation coefficients for cost were 7.02% in 2010, 5.61% in 2015 and for LOS were 3.17%, 1.40%, respectively. The average costs were 9,067,000 won in 2010 and 9,889,000 won in 2015 (p<0.0001). However, the cost in 2015 was lower than the cost applying increased fee. The costs increased in aged 50–59 years, 60-69 years, and aged ≥70 years versus in aged under 49 years. The cost was higher in Charlson comorbidity index (CCI) 3 to 4 and ≥5 than in CCI 0. The costs were lower in male, medical aid recipients, metropolises, and local hospitals in other regions in 2010. LOS decreased from 8.1 days in 2010 to 7.4 days in 2015. It decreased in male, high income group, and the group of admission via emergency room. However, it increased in higher ages and medical aid recipients, and it also increased when CCI rose. The Internal Herfindahl Index was related to LOS in 2010.
Conclusion
The variation of hospital level was small compared to the patient level. Therefore, it is important to implement applicable policies at the patient level in order to reduce cost and LOS of AMI patients.

Keyword

Medical cost; Length of stay; Acute myocardial infarction; Coronary stenting; Multilevel analysis