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연세대학교 의과대학 Yonsei Medical Journal Yonsei Medical Journal 제60권 제10호
발행연도
2019.1
수록면
976 - 983 (8page)

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Purpose: The objective of this study was to investigate whether financial coverage by the national insurance system for patientswith lower economic conditions can improve their 1-year mortality after intensive care unit (ICU) discharge. Materials and Methods: This study, conducted in a single tertiary hospital, used a retrospective cohort design to investigate dischargedICU survivors between January 2012 and December 2016. ICU survivors were classified into two groups according to theNational Health Insurance (NHI) system in Korea: medical aid program (MAP) group, including people who have difficulty payingtheir insurance premium or receive medical aid from the government due to a poor economic status; and NHI group consistingof people who receive government subsidy for approximately 2/3 of their medical expenses. Results: After propensity score (PS) matching, a total of 2495 ICU survivors (1859 in NHI group and 636 in MAP group) were includedin the analysis. Stratified Cox regression analysis of PS-matched cohorts showed that 1-year mortality was 1.31-fold higherin MAP group than in NHI group (hazard ratio: 1.31, 95% confidence interval, 1.06 to 1.61; p=0.012). According to Kaplan-Meirestimation, MAP group also showed significantly poorer survival probability than NHI group after PS matching (p=0.011). Conclusion: This study showed that 1-year mortality was higher in ICU survivors with low economic status, even if financial coveragewas provided by the government. Our result suggests the necessity of a more nuanced and multifaceted approach to policyfor ICU survivors with low economic status.

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