title: Copayment policy effects on healthcare spending and utilization by Korean lung cancer patients at end of life: a retrospective cohort design 2003-2012.
abstract: BACKGROUND
  In Korea, the National Health Insurance program has initiated various copayment policies over a decade in order to alleviate patient financial burden. This study investigated healthcare spending and utilization in the last 12 months of life among patients who died with lung cancer by various copayment policy windows.
  
  
  METHODS
  We performed a retrospective cohort study using nationwide lung cancer health insurance claims data from 2002 to 2012. We used descriptive and multivariate methods to compare spending measured by total costs, payer costs, copayments, and utilization (measured by length of stay or outpatient days). Using 1,4417,380 individual health insurance claims (inpatients: 673,122, outpatients: 744,258), we obtained aggregated healthcare spending and utilization of 155,273 individual patient (131,494 inpatient and 103,855 outpatient) records.
  
  
  RESULTS
  National spending and utilization is growing, with a significant portion of inpatient healthcare spending and utilization occurring during the end-of-life period. Specifically, inpatients were more likely to have more spending and utilization as they got close to death. As coverage expanded, copayments decreased, but overall costs increased due to increased utilization. The trends were the same in both inpatient and outpatient services. Multivariate analysis confirmed the associations.
  
  
  CONCLUSIONS
  We found evidence of the higher end of life healthcare spending and utilizations in lung cancer patients occurring as coverage expanded. The practice pattern within a hospital might be influenced by coverage policies. Health policy makers should consider initiating various health policies since these influence the long-term outcomes of service performance and overall healthcare spending and utilization.
authors.affiliation: Department of Public Health, Yonsei University College of Medicine, Seoul, Republic of Korea E-mail : thkim@yuhs.ac.
authors.forename: Sun Jung
authors.initials: SJ
authors.lastname: Kim
authors.forename: Kyu-Tae
authors.initials: KT
authors.lastname: Han
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
authors.forename: Sohee
authors.initials: S
authors.lastname: Park
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis / Q000191:economics; D005260:Female; D005102:Health Expenditures; D006291:Health Policy / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients; D007348:Insurance, Health / Q000191:economics*; D008175:Lung Neoplasms / Q000191:economics*; D008297:Male; D009313:National Health Programs / Q000191:economics*; D010045:Outpatients; D010342:Patient Acceptance of Health Care; D056910:Republic of Korea; D012189:Retrospective Studies