Cost of Care and Pattern of Medical Care Use in the Last Year of Life among Long-Term Care Insurance Beneficiaries in South Korea: Using National Claims Data

In Korea, a substantial proportion of long-term care insurance (LTCI) beneficiaries die within 1 year of seeking the benefit. This study was conducted to evaluate the pattern of medical care use and care cost during the last year of life among Korean LTCI beneficiaries between 2009 and 2013 using the national claims data. The National Health Insurance’s Senior (NHIS-Senior) cohort was used for this retrospective study. The participants were LTCI beneficiaries aged 65 or over as of 2008 who died between 2009 and 2013 (N = 30,433). Medical costs during the last year of life were highest for those who used both medical care services and long-term care (LTC) services and increased as death approached. About half of the participants were hospitalized at the time of death. The use of LTC services at the time of death increased from 13.0 to 22.8%, while those who died at home decreased from 34 to 20%. This study suggests that the use of LTC services did not reduce medical costs by substituting unnecessary inpatient hospitalization. Quality of dying should be considered one of the goals of older adult care, and provisions should be made for palliative care at home or LTC facilities.

Associations Between Private Health Insurance and Medical Care Utilization for Musculoskeletal Disorders: Using the Korea Health Panel Survey Data for 2014 to 2015

In South Korea, people may increase their medical coverage by purchasing private health insurance to augment low coverage provided by the National Health Insurance (NHI). Frequent and excessive use of medical care by those with private health insurance is an issue, especially for musculoskeletal disorders that require excessive care and contribute to moral hazard. In South Korea, since private health insurance is structurally linked to the scope of coverage with public health insurance, this increased use of medical care may adversely affect public health insurance finances. This study aimed to analyze the effects of private health insurance on medical care use for patients with musculoskeletal disorders. We used the Korea Health Panel 2014 to 2015 data that included 5622 participants who used medical care for musculoskeletal disorders in 2015. Two groups were created: those who purchased private health insurance ( n = 3588) and those without private insurance ( n = 2034). We compared their medical utilization using logistic regression, negative binomial regression, and multiple linear regression to determine the associations of private health insurance with medical care use. Medical expenditures by private health insurance purchasers were higher than those of non-purchasers for outpatient care ( P < .001), but no differences were found for inpatient care. Our findings suggest that the expansion of private health insurance further burdened the NHI financially, ultimately increasing the burden of medical expenses for the population. Research should implement demonstration studies with different groups of diseases.

Use of medical care in the 7 years before dementia in the French health insurance database in 2016

Background The entry into dementia is a period of growing interest for clinical trials and public health policies. We described the frequency of medical care use in the 7 years prior to the first dementia identification (index date). Methods All French health insurance general scheme beneficiaries aged 65 or more with an incident dementia in 2016 (identified through long-term disease registry, hospitalization diagnoses, or specific drug delivery), were matched with beneficiaries without dementia of same age, gender, area of residence. The annual cumulative incidences (ACI) of visits (GP and specialists, including outpatient hospital visits) and hospitalizations were estimated over 7 years (Y-7 to Y-1 before index date), by age (65-74, 75-84, 85-89, 90+). Results Among 274166 subjects (median age 84, 65% women), the ACI of GP visit was stable and similar between cases and controls, around 95%. The ACI of neurologist, psychiatrist and internist visit and of hospitalization in a psychiatric unit increased in cases, especially in Y-1. They were higher than in controls in the youngest age classes. The ACI of visits to a dermatologist, a rheumatologist, an ophthalmologist, a dentist and for women a gynecologist, were lower in cases than in controls, with an increasing difference in the last years before dementia care. Similar patterns were observed in the oldest exclusively (generally ≥85 yo) for pneumologist, cardiologist, nephrologist, and in a lesser extent, endocrinologist visit. The ACI of hospitalizations increased with time in both groups, with a peak in Y-1 in cases. They were higher in cases than in controls in the youngest age classes. Conclusions The increase in hospitalization rate in Y-1 suggests a decline in clinical status leading to the diagnosis or a weakening at the time of entry into dementia. The lesser use of a specialist other than neurologist or psychiatrist suggests a focus of care around dementia, possibly to the detriment of the care of comorbidities. Key messages As most patients visit their GP at least yearly, specific GPs training could help to make a timely diagnosis of major neurocognitive disorders. The lesser use of a specialist other than neurologist or psychiatrist suggests a focus of care around dementia, possibly to the detriment of the care of comorbidities.

Effect of frailty on resource use and cost for Medicare patients

Aim: The effects of frailty and multiple chronic conditions (MCCs) on cost of care are rarely disentangled in archival data studies. We identify the marginal contribution of frailty to medical care cost estimates using Medicare data. Materials & methods: Use of the Faurot frailty score to identify differences in acute medical events and cost of care for patients, controlling for MCCs and medication use. Results: Estimated marginal cost of frailty was US$10,690 after controlling for demographics, comorbid conditions, polypharmacy and use of potentially inappropriate medications. Conclusion: Frailty contributes greatly to cost of care, but while often correlated, is not synonymous with MCCs. Thus, it is important to control separately for frailty in studies that compare medical care use and cost.