title: Higher cost sharing for visiting general hospitals and the changing trend in the first-visited healthcare organization among newly diagnosed hypertension patients.
abstract: Unnecessary use of high-quality resources in general hospitals hinders treatment of patients with urgent and complicated conditions. Thus, the Korean Government has sought to reduce general hospital visiting of patients with 52 mild diseases, including hypertension. The higher cost sharing for medical expenses and medications from general hospitals were enacted in 2009 and 2011, respectively.We determined whether these regulations were effective through evaluating changing trends in first-visited healthcare organizations and defined the first visiting healthcare organization level (primary clinics, hospital, and general hospital) as an outcome measure.Data of 32,830 mild hypertension patients from 2004 to 2013 were retrieved from the Korean National Health Insurance Service National Sample Cohort. This was a retrospective study involving a large national cohort with patient samples (representing 2% of the total Korean population) stratified on the basis of sociodemographic information.Mutinomial logistic regression were performed for the first visiting to different health organizations, compared to the first visiting to primary clinics.Patients in 2012 and 2013 had significantly lower odds ("2012": 0.68, 95% confidence interval [CI]: 0.56-0.81/"2013": 0.66, 95% CI 0.54-0.81) of first visiting general hospitals compared with those in 2008, although decreased tendencies (albeit nonsignificant) were already evident in 2010 and 2011.Thus, government health policies for cost-containment seem effective in decreasing first visiting of general hospitals among patients with mild essential hypertension. These policies have since extended to Medical Aid beneficiaries; thus, it is needed to continue monitor their results carefully.
authors.affiliation: Department of Preventive Medicine Institute of Health Services Research, College of Medicine Department of Public Health, Graduate School Department of Hospital Management, The Graduate School of Public Health, Yonsei University, Seoul, South Korea.
authors.forename: Jaeyong
authors.initials: J
authors.lastname: Shin
authors.forename: Young
authors.initials: Y
authors.lastname: Choi
authors.forename: Sang Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
mesh_terms: D000368:Aged; D015897:Comorbidity; D003363:Cost Control; D017047:Cost Sharing / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006769:Hospitals, General / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D056910:Republic of Korea; D012189:Retrospective Studies; D012959:Socioeconomic Factors