Abstract
ObjectivesThere do not appear to be many studies which have examined the socio-economic burden and medical factors influencing the mortality and hospital costs incurred by patients with cardiac arrest in South Korea. We analyzed the differences in characteristics, medical factors, mortality, and costs between patients with national health insurance and those on a medical aid program.MethodsWe selected patients (≥20 years old) who experienced their first episode of cardiac arrest from 2004 to 2015 using data from the National Health Insurance Service database. We analyzed demographic characteristics, insurance type, urbanization of residential area, comorbidities, treatments, hospital costs, and mortality within 30 days and one year for each group. A multiple regression analysis was used to identify an association between insurance type and outcomes.ResultsAmong the 487,442 patients with cardiac arrest, the medical aid group (13.3% of the total) had a higher proportion of females, rural residents, and patients treated in low-level hospitals. The patients in the medical aid group also reported a higher rate of non-shockable conditions; a high Charlson Comorbidity Index; and pre-existing comorbidities, such as hypertension, diabetes mellitus, and renal failure with a lower rate of providing a coronary angiography. The national health insurance group reported a lower one-year mortality rate (91.2%), compared to the medical aid group (94%), and a negative association with one-year mortality (Adjusted OR 0.74, 95% CI 0.71–0.76). While there was no significant difference in short-term costs between the two groups, the medical aid group reported lower long-term costs, despite a higher rate of readmission.ConclusionsMedical aid coverage was an associated factor for one-year mortality, and may be the result of an insufficient delivery of long-term services as reflected by the lower long-term costs and higher readmission rates. There were differences of characteristics, comorbidities, medical and hospital factors and treatments in two groups. These differences in medical and hospital factors may display discrepancies by type of insurance in the delivery of services, especially in chronic healthcare services.
Highlights
Global incidence rates of cardiac arrest and corresponding outcomes show variations across continents due to differences in healthcare systems, race, and comorbidities [1]
Emergency Medical Services (EMS) providers transport all of-hospital cardiac arrests (OHCA) patients to the emergency department (ED) under the EMS cardiopulmonary resuscitation (CPR) protocol, even if there has been a return of spontaneous circulation (ROSC) [26,27]
We identified patients with a first diagnosis of cardiopulmonary arrest during their index hospitalization based on the main-diagnosis, the 1st-4th sub-diagnosis claims codes (I46.0–9), or the first claim codes for CPR procedures (M5871, M5873-7), and the relevant implantable cardioverter defibrillator (ICD)-10 codes [3,4,28] using the National Health Insurance Services (NHIS) claims data from 2004 to 2015, with a one year follow-up through 2016
Summary
Global incidence rates of cardiac arrest and corresponding outcomes show variations across continents due to differences in healthcare systems, race, and comorbidities [1]. High mortality rates after cardiac arrest demand time-sensitive intensive hospital care services and poor neurologic outcomes after survival demand longterm hospitalization for chronic care, incurring high hospital costs, despite global variations [5,10,11]. Several socioeconomic factors, such as age, sex [12], rural residence [13], and household income [14], may affect incidences and outcomes for patients with cardiovascular disease and cardiac arrest [15,16]. Type of insurance coverage may influence the delivery of medical services before admission and during hospitalization, affecting the outcome and management of comorbidities in patients with cardiac arrest [18,19,20,21,22]
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