Evidence of a Broken Healthcare Delivery System in Korea: Unnecessary Hospital Outpatient Utilization among Patients with a Single Chronic Disease Without Complications.
10.3346/jkms.2014.29.12.1590
- Author:
Jin Yong LEE
1
;
Min Woo JO
;
Weon Seob YOO
;
Hyun Joo KIM
;
Sang Jun EUN
Author Information
1. Public Health Medical Service, Seoul National University Boramae Medical Center, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Primary Health Care;
Costs and Cost Analysis;
Utilization;
Referral and Consultation
- MeSH:
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
- From:Journal of Korean Medical Science
2014;29(12):1590-1596
- CountryRepublic of Korea
- Language:English
-
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.
