Evidence of a Broken Healthcare Delivery System in Korea: Unnecessary Hospital Outpatient Utilization among Patients with a Single Chronic Disease Without Complications

다국어 초록 (Multilingual Abstract)

This study aims to estimate the volume of unnecessarily utilized hospital outpatient servicesin Korea and quantify the total cost resulting from the inappropriate utilization. Theanalysis included a sample of 27,320,505 outpatient claims from the 2009 NationalInpatient Sample database. Using the Charlson Comorbidity Index (CCI), patients wereconsidered to have received ‘unnecessary hospital outpatient utilization’ if they had a CCIscore of 0 and were concurrently admitted to hospital for treatment of a single chronicdisease – hypertension (HTN), diabetes mellitus (DM), or hyperlipidemia (HL) – withoutcomplication. Overall, 85% of patients received unnecessary hospital services. Alsohospitals were taking away 18.7% of HTN patients, 18.6% of DM and 31.6% of HL fromclinics. Healthcare expenditures from unnecessary hospital outpatient utilization wereestimated at: HTN (94,058 thousands USD, 38.6% of total expenditure); DM (17,795thousands USD, 40.6%) and HL (62,876 thousands USD, 49.1%). If 100% of patients whoreceived unnecessary hospital outpatient services were redirected to clinics, the estimatedsavings would be 104,226 thousands USD. This research proves that approximately 85% ofhospital outpatient utilizations are unnecessary and that a significant amount of money iswasted on unnecessary healthcare services; thus burdening the National Health InsuranceService (NHIS) and patients.

참고문헌 (Reference)

1 김록영, "입원 환자 표본 개발에 관한 연구: 국민건강보험 청구자료를 중심으로" 한국보건행정학회 23 (23): 152-161, 2013

2 이재호, "일차의료 표준모형과 질 평가체계" 대한의사협회 56 (56): 866-880, 2013

3 박종혁, "유방암 수술 후 장기 생존의 예측인자로서 Charlson Comorbidity Index: 한국에서 전국적인 후향적 코호트 연구" 한국유방암학회 13 (13): 409-417, 2010

4 김효정, "외래 본인부담률 인상이 상급종합병원과 종합병원 외래 의료이용에 미친 영향" 한국보건행정학회 23 (23): 19-34, 2013

5 조수진, "당뇨병 환자의 동반상병 점수에 따른 상급종합병원 이용 차이" 한국보건행정학회 21 (21): 527-540, 2011

6 Kwon S, "Thirty years of national health insurance in South Korea : lessons for achieving universal health care coverage" 24 : 63-71, 2009

7 Song YJ, "The South Korean health care system" 52 : 206-209, 2009

8 Chun CB, "Republic of Korea : health system review" 11 : 1-184, 2009

9 Kwon S, "Payment system reform for health care providers in Korea" 18 : 84-92, 2003

10 Organisation for Economic Co-operation and Development, "OECD healthcare quality review: Korea, assessment and recommendation"

11 Sundararajan V, "Cross-national comparative performance of three versions of the ICD-10 Charlson index" 45 : 1210-1215, 2007

12 이재호, "Association of the Length of Doctor-Patient Relationship with Primary Care Quality in Seven Family Practices in Korea" 대한의학회 28 (28): 508-515, 2013