title: Evidence of a broken healthcare delivery system in korea: unnecessary hospital outpatient utilization among patients with a single chronic disease without complications.
abstract: This study aims to estimate the volume of unnecessarily utilized hospital outpatient services in Korea and quantify the total cost resulting from the inappropriate utilization. The analysis included a sample of 27,320,505 outpatient claims from the 2009 National Inpatient Sample database. Using the Charlson Comorbidity Index (CCI), patients were considered to have received 'unnecessary hospital outpatient utilization' if they had a CCI score of 0 and were concurrently admitted to hospital for treatment of a single chronic disease - hypertension (HTN), diabetes mellitus (DM), or hyperlipidemia (HL) - without complication. Overall, 85% of patients received unnecessary hospital services. Also hospitals were taking away 18.7% of HTN patients, 18.6% of DM and 31.6% of HL from clinics. Healthcare expenditures from unnecessary hospital outpatient utilization were estimated at: HTN (94,058 thousands USD, 38.6% of total expenditure); DM (17,795 thousands USD, 40.6%) and HL (62,876 thousands USD, 49.1%). If 100% of patients who received unnecessary hospital outpatient services were redirected to clinics, the estimated savings would be 104,226 thousands USD. This research proves that approximately 85% of hospital outpatient utilizations are unnecessary and that a significant amount of money is wasted on unnecessary healthcare services; thus burdening the National Health Insurance Service (NHIS) and patients.
authors.affiliation: Public Health Medical Service, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Jin Yong
authors.identifier: 0000-0002-7752-2697
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Min-Woo
authors.identifier: 0000-0002-4574-1318
authors.initials: MW
authors.lastname: Jo
authors.affiliation: Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Weon-Seob
authors.identifier: 0000-0002-5457-9367
authors.initials: WS
authors.lastname: Yoo
authors.affiliation: Department of Public Health, Graduate School of Konyang University, Daejeon, Korea.
authors.forename: Hyun Joo
authors.identifier: 0000-0001-5784-3576
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Sang Jun
authors.identifier: 0000-0001-5868-1679
authors.initials: SJ
authors.lastname: Eun
mesh_terms: D002908:Chronic Disease / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D010044:Outpatient Clinics, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000191:economics* / Q000706:statistics & numerical data*; D014600:Utilization Review
keywords: Costs and Cost Analysis; Primary Health Care; Referral and Consultation; Utilization