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Effect of health insurance type on health care utilization in patients with hypertension: a national health insurance database study in Korea

机译：健康保险类型对高血压患者医疗保健利用的影响：韩国国家健康保险数据库研究

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Background Higher utilization of healthcare services has been observed among individuals who receive public aid compared to individuals who do not receive public aid in many countries. However, no systematic investigations have explored whether this pattern of higher utilization persists after correcting for a number of factors in Korea. In this study, we sought to examine whether the type of health insurance, wage-based contributory insurance (Health Insurance, HI) or government-subsidized public assistance (Medical Aid, MA), affects the utilization of inpatient services after controlling for baseline patient and institutional characteristics among patients with hypertension in Korea. Methods The Korean National Health Insurance claims database from 2006 and 2007 was used for analysis. To avoid biased estimates, we determined the most appropriate type of multivariate model for each outcome variable: a logistic regression model for the likelihood of hospitalization, a zero-inflated negative binomial model for the length of stay (LOS), and a generalized linear model with a log-link function for hospitalization costs. Results Adjusted odds ratio (OR) and factor changes showed that MA patients (n?=?21,539) had a significantly higher likelihood of hospitalization (OR: 1.41-1.71), average LOS per patient (factor change: 1.31-1.42), and hospitalization costs per patient (factor change: 1.10-1.41) compared to HI patients (n?=?304,027). Conclusions The pattern of higher healthcare utilization among MA patients persists even after controlling for baseline health conditions. This finding confirms that the type of health insurance affects the utilization of healthcare resources, and suggests that effective strategies are necessary to prevent the potential overutilization of inpatient care by MA patients with hypertension in Korea.
机译：背景技术在许多国家，与没有获得公共援助的个人相比，获得公共援助的个人中医疗服务的利用率更高。但是，在校正了韩国的许多因素之后，没有系统的调查来探讨这种高利用率的模式是否仍然存在。在这项研究中，我们试图检查健康保险，基于工资的缴费型保险（健康保险，HI）或政府补贴的公共援助（医疗援助，马萨诸塞州）的类型在控制基线患者后是否会影响住院服务的利用高血压患者的病情和机构特征。方法使用2006年和2007年的韩国国民健康保险理赔数据库进行分析。为避免估计结果有偏差，我们为每个结果变量确定了最合适的多元模型类型：住院可能性的逻辑回归模型，住院天数（LOS）的零膨胀负二项式模型和广义线性模型具有日志链接功能以节省住院费用。结果校正比值比（OR）和因子变化显示MA患者（n？=？21,539）的住院可能性更高（OR：1.41-1.71），每位患者的平均LOS（因子变化：1.31-1.42）和与HI患者相比，每位患者的住院费用（因子变化：1.10-1.41）（n = 304,027）。结论即使控制了基线健康状况，MA患者中更高的医疗利用率仍然存在。这一发现证实了健康保险的类型会影响医疗资源的利用，并表明必须采取有效的策略来防止韩国的MA高血压患者过度利用住院医疗服务。

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