Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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Relationship between the Distribution of Comorbidity and Length of Stay and Medical Cost for Planning Integrated Community Care Services among Inpatients at a Seoul Municipal Hospital

지역사회 통합 케어서비스 방안 마련을 위한 시립병원 입원환자의 동반질환 분포와 재원일수 및 진료비와의 관련성

  • Kim, Jae-Hyun (Department of Health Administration, Dankook University College of Health Science) ;
  • Noh, Jin-Won (Department of Health Administration, Dankook University College of Health Science) ;
  • Lee, Yunhwan (Department of Preventive Medicine and Public Health, Ajou University School of Medicine) ;
  • So, Yekyeong (Seoul Health Foundation) ;
  • Hong, Hyeonseok (Seoul Health Foundation)
  • 김재현 (단국대학교 보건과학대학 보건행정학과) ;
  • 노진원 (단국대학교 보건과학대학 보건행정학과) ;
  • 이윤환 (아주대학교 의과대학 예방의학교실) ;
  • 소예경 (서울특별시 공공보건의료재단) ;
  • 홍현석 (서울특별시 공공보건의료재단)
  • Received : 2019.08.12
  • Accepted : 2019.10.01
  • Published : 2019.12.31
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Abstract

Background: This study is to investigate the association between the distribution of multimorbidity and length of stay and medical expenses among inpatients in a municipal hospital to achieve an integrated care setting. Methods: We used the exploratory factor analysis and the generalized estimating equation model to analyze the data from patients living in the northeast region of Seoul, who were hospitalized from January 2017 to December 2017 in a municipal hospital. Results: As a result of the factor analysis, seven types of multiple chronic diseases were classified. Among the elderly patients admitted to municipal hospitals, the burden of medical expenses was mainly influenced by the length of stay (B=310,719, p-value <0.0001), not the type of disease (all not significant). Length of stay were mainly due to psychiatric illness (factor 1: B=4.323, p-value <0.0001) related to the brain and metabolic diseases (factor 2: B=2.364, p-value=0.003). Conclusion: This study showed that the medical expenses of the elderly patients were largely due to prolonged hospitalization, not multimorbidity. Therefore, it is necessary to develop an integrated care paradigm strategy cope with the multimorbidity of the elderly in the community and to alleviate the socio-economic burden.

Keywords

References

  1. Jung ES, Park MJ. Factors affecting unmet medical care of the elderly with chronic illness. Proceedings of the 3rd Korea Medical Panel Conference; 2011 Dec 1; Seoul, Korea. Wonju: Health Insurance Policy Research Institute, National Health Insurance Service; 2011.
  2. Jang SN, Kim DH. Trends in the health status of older Koreans. J Am Geriatr Soc 2010;58(3):592-598. DOI: https://doi.org/10.1111/j.1532-5415.2010.02744.x.
  3. Jung YH, Ko SJ, Kim EJ. A study on the effective chronic disease management. Sejong: Korea Institute for Health and Social Affairs; 2013.
  4. Jang SN. Chronic illnesses and limited daily activities in the Korean elderly. Health Welf Policy Forum 2015;(225):6-17.
  5. Korean Statistical Information Service. Medical service usage status. Sejong: Ministry of Health and Welfare; 2017.
  6. Bo M, Fonte G, Pivaro F, Bonetto M, Comi C, Giorgis V, et al. Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients. Geriatr Gerontol Int 2016;16(3):314-321. DOI: https://doi.org/10.1111/ggi.12471.
  7. Bang HJ, Lee KS. Determinants of length of stay in geriatric hospitals: focused on Alzheimer dementia's inpatients. J Korea Contents Assoc 2013;13(12):900-909. DOI: https://doi.org/10.5392/jkca.2013.13.12.900.
  8. Cai Q, Salmon JW, Rodgers ME. Factors associated with long-stay nursing home admissions among the U.S. elderly population: comparison of logistic regression and the Cox proportional hazards model with policy implications for social work. Soc Work Health Care 2009;48(2):154-168. DOI: https://doi.org/10.1080/00981380802580588.
  9. Kim D, Kim M, Hwang J. Factors related with cost increasing: focusing on health care inpatient expenditure. Wonju: Health Insurance Review and Assessment Service; 2010.
  10. Noh YK, Sun WD, Yoon JR, Won CW, Lee DW, Lee DH. A study on the role of elderly care facilities and hospitals. Seoul: The Korean Geriatrics Society; 2010.
  11. Kwon SM, Kim HS, Won JW, Lee JY, Kim HC, Chung YI. A study on improvement of elderly medical service system. Wonju: National Health Insurance Service; 2013.
  12. Yoon JL. Long-term care insurance scheme for the elderly and role of long-term care hospitals. Healthc Policy Forum 2008;6(3):28-39.
  13. Shon C, Lee S, Hwang J. Understanding factors associated with unmet need for outreach community health service among older adults in Seoul. J Korea Gerontol Soc 2019;39(2):213-229. DOI:https://doi.org/10.31888/jkgs.2019.39.2.213.
  14. Ha JS, Kim JH, Lim JH, Kim JY. Qualitative research on integrated support through health, medical and welfare network: based on the experience of 301 Network Service users in Seoul Northern Municipal Hospital. Korean J Soc Welf 2017;69(2):143-169. DOI:https://doi.org/10.20970/kasw.2017.69.2.005.
  15. Heo J, Yoon NH, Hwang SE, Hwang J. Health impact evaluation of the 1st year outreach community centers initiative in Seoul: focusing on visiting health services for the elderly. Health Soc Welf Rev 2019;39(2):103-130. DOI: https://doi.org/10.15709/hswr.2019.39.2.103.
  16. Lee KS. Suggestions for designing a chronic disease management model in Korea. Proceedings of the 1st Chronic Disease Management Forum; 2013 Oct 1; Seoul, Korea. Cheongju: Korea Centers for Disease Control and Prevention; 2013.
  17. Yoon SJ. Future directions of chronic disease management in South Korea. J Korean Med Assoc 2012;55(5):414-416. DOI: https://doi.org/10.5124/jkma.2012.55.5.414.
  18. Ministry of Health and Welfare. Community integrated care basic plan. Sejong: Ministry of Health and Welfare; 2018.
  19. Trust for America's Health. Prevention for a healthier America. Washington (DC): Trust for America's Health; 2008.
  20. Russell LB. Prevention's potential for slowing the growth of medical spending. Washington (DC): National Coalition on Health Care; 2007.
  21. Woolf SH, Husten CG, Lewin LS, Marks JS, Fielding JE, Sanchez EJ. The economic argument for disease prevention: distinguishing between value and savings. Washington (DC): Partnership for Prevention; 2009.