Trend and Characteristics of High Cost Patients in Health Insurance

건강보험 고액진료비 환자의 추이 및 특성 분석

  • Jeong, Seo Hyun (Department of Health Information and Management, Chungbuk National University College of Medicine) ;
  • Jang, Ho Yeon (Department of Health Information and Management, Chungbuk National University College of Medicine) ;
  • Kang, Gil Won (Department of Health Information and Management, Chungbuk National University College of Medicine)
  • 정서현 (충북대학교 의과대학 의료정보학 및 관리학교실) ;
  • 장호연 (충북대학교 의과대학 의료정보학 및 관리학교실) ;
  • 강길원 (충북대학교 의과대학 의료정보학 및 관리학교실)
  • Received : 2018.07.31
  • Accepted : 2018.08.21
  • Published : 2018.12.31


Background: The purpose of this study is to propose an analysis of trends and characteristics of high-cost patients who take over 40% of total national health insurance medical expenses. Methods: It has been analyzed the tendency of high-cost patients by open data based on the medical history information of 1 million people among national health insurance subscriber from 2002 to 2015. To conduct detailed study of characteristics of high-cost patients, multiple regression has been performed by sex, age, residence, main provider, and admission status based on the top 5% group. Results: The amount of medical expenses and the number of high-cost patients have gradually increased in decades. The number of high-cost patients for Korean won (KRW) 5,000,000 category has increased by 7.6 times, KRW 10,000,000 category has increased by 14.1 times in comparing of year 2002 and 2015. Top 5% medical expenses have increased by 4.6 times. In consideration of the characteristics of patients, the incidence of high medical expenses has been higher in female patients than male ones, the older patients than in the younger. Patients residence in Gyeonsang or Jeonla province have had a high incidence of medical expenses than other area. The disease including dementia, cerebral infarction, and cerebrovascular disease for high-cost patients has been also increased. Conclusion: The major increase factor for high medical expenses is the aging of population. The elderly population receiving inpatient care residing in the province that increases high medical costs have to management. There is an urgent need to develop a mechanism for predicting and managing the cost of high-cost medical expenses for patients who have a heavy financial burden.

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Figure 1. Trends of the proportion of high-cost patients in total medi-cal expense. KRW, Korean won.

Table 1. Annual medical expense by quartile

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Table 2. Proportions of high-cost patients in total ME

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Table 3. General characteristics of top 5% high-cost patients

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Table 4. Multiple regression model of high-cost patients

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Table 5. Average LOS and visit number by patients group

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Table 6. Diseases characteristics of high-cost patients

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