Impacts of Financial Coverage on Long-Term Outcome of ICU Survivors with Lower Economic Status: Cohort Study Under National Health Insurance System in South Korea

Abstract

Background: The objective of this study was to investigate whether financial coverage by the national insurance system for patients with lower economic conditions can improve their 1-year mortality after intensive care unit (ICU) discharge. Methods: The present study, conducted in a single tertiary academic hospital, used a retrospective observational design to investigate discharged ICU survivors who were admitted to ICU. The ICU survivors were classified into two groups according to the National Health Insurance (NHI) system in Korea: Medical Aid Program (MAP) group, including people who have difficulty paying their insurance premium or receive medical aid from the government due poor economic status, and NHI group consisting of people who receive government subsidy for approximately 2/3 of their medical expenses. Findings: A total of 18,070 ICU survivors were included in the analysis, with 17,443 in NHI group and 627 in MAP group. After PS matching, a total of 2,429 ICU survivors (1,806 in NHI group and 623 in MAP group) were included in the analysis. Stratified Cox regression analysis of PS-matched cohorts showed that 1-year mortality was 1.32-fold higher in MAP group than in NHI group. Competing risk analysis showed that 1-year mortality due to injury or trauma was significantly higher in MAP group than in NHI group. Interpretation This study showed that 1-year mortality was higher in ICU survivors with low economic status even if financial coverage was provided by the government; this was even more evident in cases involving mortality due to trauma or injury. Funding: None Declaration of Interest: The authors declare that they have no competing interests. Ethical Approval: This retrospective cohort study was conducted with approval from the Institutional Review Board (IRB) of Seoul National University Bundang Hospital (SNUBH) (IRB approval number: B-1806/474-105).