Psychiatric inpatient expenditures and public health insurance programmes: analysis of a national database covering the entire South Korean population.
BACKGROUND
Medical spending on psychiatric hospitalization has been reported to impose a tremendous socio-economic burden on many developed countries with public health insurance programmes. However, there has been no in-depth study of the factors affecting psychiatric inpatient medical expenditures and differentiated these factors across different types of public health insurance programmes. In view of this, this study attempted to explore factors affecting medical expenditures for psychiatric inpatients between two public health insurance programmes covering the entire South Korean population: National Health Insurance (NHI) and National Medical Care Aid (AID).


METHODS
This retrospective, cross-sectional study used a nationwide, population-based reimbursement claims dataset consisting of 1,131,346 claims of all 160,465 citizens institutionalized due to psychiatric diagnosis between January 2005 and June 2006 in South Korea. To adjust for possible correlation of patients characteristics within the same medical institution and a non-linearity structure, a Box-Cox transformed, multilevel regression analysis was performed.


RESULTS
Compared with inpatients 19 years old or younger, the medical expenditures of inpatients between 50 and 64 years old were 10% higher among NHI beneficiaries but 40% higher among AID beneficiaries. Males showed higher medical expenditures than did females. Expenditures on inpatients with schizophrenia as compared to expenditures on those with neurotic disorders were 120% higher among NHI beneficiaries but 83% higher among AID beneficiaries. Expenditures on inpatients of psychiatric hospitals were greater on average than expenditures on inpatients of general hospitals. Among AID beneficiaries, institutions owned by private groups treated inpatients with 32% higher costs than did government institutions. Among NHI beneficiaries, inpatients medical expenditures were positively associated with the proportion of patients diagnosed into dementia or schizophrenia categories. However, for AID beneficiaries, inpatient medical expenditures were positively associated with the proportion of all patients with a psychiatric diagnosis that were AID beneficiaries in a medical institution.


CONCLUSIONS
This study provides evidence that patient and institutional factors are associated with psychiatric inpatient medical expenditures, and that they may have different effects for beneficiaries of different public health insurance programmes. Policy efforts to reduce psychiatric inpatient medical expenditures should be made differently across the different types of public health insurance programmes.
Chung
Woojin
W
Department of Health Policy and Management, Graduate School of Public Health and Institute of Health Services Research, Yonsei University, Seoul 120-752, Republic of Korea. wchung@yuhs.ac
D000328:Adult; D000367:Age Factors; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000639:trends; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000639:trends; D007358:Insurance, Psychiatric / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D015397:Program Evaluation; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D055815:Young Adult
Med Care. 1998 Jun;36(6):879-91
9630129
BMC Health Serv Res. 2007 Aug 17;7:129
17705853
Hosp Community Psychiatry. 1974 Aug;25(8):531-3
4842834
Can J Psychiatry. 1996 Nov;41(9):572-7
8946080
Health Aff (Millwood). 2000 Jan-Feb;19(1):56-71
10645073
Eur Psychiatry. 1999 Dec;14(8):462-7
10683633
Psychiatr Q. 1992 Fall;63(3):265-78
1488466
Med Care. 2007 Feb;45(2):116-22
17224773
Soc Sci Med. 2002 Jan;54(1):1-10
11820673
Psychiatr Serv. 2003 Feb;54(2):188-94
12556599
Health Aff (Millwood). 1990 Spring;9(1):5-18
2182497
Issues Ment Health Nurs. 2008;29(1):21-36
18214776
Eur Arch Psychiatry Clin Neurosci. 1999;249(3):123-7
10433125
Health Serv Res. 2002 Apr;37(2):315-40
12035996
Arch Gen Psychiatry. 1984 Oct;41(10):971-8
6477055
J Ment Health Policy Econ. 2006 Mar;9(1):15-24
16733268
Fam Community Health. 2006 Jul-Sep;29(3):169-85
16775467
Psychiatr Serv. 1998 Sep;49(9):1173-9
9735958
Health Care Financ Rev. 1997 Spring;18(3):177-93
10170347
Commun Med. 2007;4(2):141-52
18052814
Soc Sci Med. 2009 Mar;68(6):1137-44
19167140
Psychiatr Serv. 1997 Apr;48(4):485-90
9090731
Psychiatr Serv. 2001 Jun;52(6):841-3
11376239
Health Aff (Millwood). 2001 Mar-Apr;20(2):214-24
11260946
Acta Psychiatr Scand. 1982 Jan;65(1):1-14
7187171
Milbank Q. 1997;75(1):5-10
9063298
Health Policy. 2005 Oct;74(2):115-21
16153472
Health Aff (Millwood). 2006 May-Jun;25(3):614-22
16684724
Acta Psychiatr Scand Suppl. 2001;(410):82-8
11863057
Psychiatr Serv. 2005 Aug;56(8):988-94
16088017
J Health Soc Behav. 1983 Jun;24(2):186-98
6886372
J Korean Med Sci. 2008 Apr;23(2):167-75
18436996
J Health Econ. 1992 Aug;11(2):173-81
10122977
Isr J Psychiatry Relat Sci. 2003;40(4):240-7
14971125
J Health Econ. 1996 Feb;15(1):127-37
10157426
Am J Geriatr Psychiatry. 2003 Nov-Dec;11(6):648-57
14609805
Health Aff (Millwood). 2003 Sep-Oct;22(5):97-109
14515885
Psychiatr Serv. 2007 Aug;58(8):1041-8
17664514
Pharmacoeconomics. 1999 Jun;15(6):597-610
10538332
J Health Econ. 1992 May;11(1):63-84
10119757