This paper attempts to take an in-depth study of differences in medical expenses according to medical security type and its factors which have effect on the cost. The medical expense of 1,904 patients who had got percutaneous coronary intervention at a national university hospital was analyzed using covariance and hierarchical regression analysis. It can be summarized as follows.
1. There was a distinctive clinical characteristic difference according to medical security type. In the hemodialysis treatment, the group with medical aid had a high rate for hemodialysis and did so with past renal failure history. The average number of indicatio morbi was over 3 in a national health insured group but the health aid one had 0. On the other hand, the health aid group had a higher rate in the service utilization in emergency departments compared to others. The national heath insured group had 3 days of stay but the health aid one had over 5 days of stay in a hospital. The latter one also had a longer average length of hospitalization. The national health insured group had a high survival rate but the health aid one had high mortality.
2. There was a distinctive difference caused by medical expenses and its scheme according to medical security type. The total medical expenses was analyzed to get the health service utilization quantity and it resulted in that health aid group had low cost of non-benefit medical expenses clauses and optional medical expenses significantly. The medical aid group had higher doctor and hospital charges, meal bills, medication and injection fees. On the other hand, national health insured group had considerably high rate on operation expenses. The medical expense per day was analyzed to figure out the medical service utilization intensity and it resulted in low cost of non-benefit service for medical aid group.
3. The difference of medical expenses claimed between national health insurance and medical aid group differentiated by the hospital added rate applied to the medical practice was 129,000won per patient. This study tried to take a measurement at community benefits not a cost difference caused by medical service utilization but the institutional difference .
4. The major factors effecting on the inpatient medocal expenses of percutaneous coronary intervention were as below. The detailed factors effecting on the total medical expense were past percutaneous coronary intervention history, the number of lesions, the number of stent inserted, the length of stay, the treatment outcome and the type of medical security. The factors effecting on total medical expenses per day were gender, age, the number of stent inserted, utilization of emergency room, the length of stay, the treatment outcome and the type of medical security. The most plausible explanation for variation was medical treatment related variables. The type of medical security was the meaningful variation effecting on the total medical expense, the total medical expense per day, non-benefit medical expenses per day and optional expenses per day.
To conclude, the patients who got the coronary intervention showed the different medical care utilization and the cost associated with the medical security type. The medical aid group had a longer length of stay and lower cost in non-benefit medical expenses, optional medical expenses, optional medical expense per day. The average inpatient charge 129,000 won less per patient in medical aid group because of the hospital added rate applied differently. The most influencing factors contributing to inpatient medical expenses of percutaneous coronary intervention was treatment related variables. Besides, the type of medical security had signigicant relevance to the inpatient medical expenses.