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KMID : 1170320170230040083
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Korean Journal of Health Economics and Policy
2017 Volume.23 No. 4 p.83 ~ p.103
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High-need, high-cost older adults in South Korea: Prevalence and contributing factors
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Jung Young-Il
Kim Hong-Soo
Yi Jae-Yoon
Park Jung-Min
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Abstract
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The purpose of this study is to examine the characteristics of high-need, high-cost older adults and analyze associated factors. Using a representative sample from the National Health Insurance Service―National Sample Cohort (2009-2012), we examine using dynamic panel modeling approaches, the effects of socio-demographic factors and previous medical utilizations on any inpatient hospitalizations, potentially preventable hospitalizations (PPHs), emergency department (ED) visits, and being in the top 10% of the healthcare expenditure group. Among patients aged 65 years and older (n=113,612), any-hospitalization, PPH, and any-ED utilization rates were 26.18%, 2.51%, 9.12%, respectively. The average annual expenditure per person for the top 10% highest cost group was 11,260,000 won. Common factors contributing to high utilization and high expenditure were old age, rural residence (except cost), having multimorbidity, and previous utilization history. A low continuity of care (COC) led to increased hospitalizations and ED visits, but a high COC was associated with PPH and being in the top 10% of the expenditure group. After controlling for other factors, previous-year utilization accounted for higher hospitalization rates, more PPHs, and higher ED utilization. Having high cost in the previous year increased the likelihood of being in the top 10% cost group in the current year. This study reveals great variation in healthcare needs within the elderly population, influenced not only by socio-demographic and health status but also by previous healthcare utilization patterns. Necessary are policy efforts and innovation to build a health system to better serve a rapidly increasing older population with complex care needs.
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KEYWORD
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healthcare expenditure, hospitalization, emergency visit, aging, national health insurance
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