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KMID : 1142820230070010001
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Bio, Ethics and Policy
2023 Volume.7 No. 1 p.1 ~ p.24
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Current Status of Implementation of the Decision to Forgo Life-Sustaining Treatment through Big Data of the National Health Insurance Service
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Kim Jung-A Claire
Kim Do-Kyong
Mun Soo-Kyeong
Son Min-Kook
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Abstract
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With the enactment of the Act on Determination of Life-Sustaining Treatment and the revision of its Enforcement Decree in 2016, the scope of end-of-life life-sustaining treatment was established as a legal term in South Korea. Based on the Act, decisions on life-sustaining treatment can be made and implementation of that decisions can be proceeded. Therefore, it is possible to quantitatively trace life-sustaining treatment decisions occurring in Korea through national data sources such as health insurance data. This research uses the National Health Insurance Service health screening cohort data base from 2018 to 2019, when a pilot project on life-sustaining treatment decisions was conducted, extracting data from people who made decisions such as forgoing life-sustaining treatment. As a nested case-control study, a case group and a control group were compared and their characteristics and medical practices were analyzed. After the extraction, the case group had a higher ratio of males, a younger age of 75.1 years, and a higher percentage of intensive care unit admission than the control group. The case group and the control one showed differences in residence, income level, degree of disability, cause of death, place of death, intensive care unit admission, and Charlson Comorbidity Index (CCI). Death due to neoplasms, diseases of blood and hematopoietic organs and specific disorders invading the immune mechanism, death in a tertiary hospital, and CCI of 3 or higher were the highest in the case group. When 1,123 patients in the case group and 1,123 patients in the control group were compared after matching, there were statistically significant differences between two groups in terms of CPR, ventilator support, and use of vasopressors both 6 months before and 1 month before the death. The results of this study suggest that the Act on Determination of Life-Sustaining Treatment has only a limited effect on end-of-life care. Follow-up studies that directly track the current status of end-of-life care and quality of life are needed.
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KEYWORD
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end-of-life, life-sustaining treatment, the Act on Determination of Life-Sustaining Treatment, National Health Insurance Service, big data
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