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관상동맥 스텐트를 삽입한 급성 심근경색 환자의 진료비 및 재원일수 관련 요인에 대한 다수준분석: 2010년과 2015년 국민건강보험공단 맞춤형 데이터베이스 자료를 바탕으로

Multilevel Analysis of Factors Related to Cost and Length of Stay in Acute Myocardial Infarction Patients with Coronary Stenting: Based on Korean National Health Insurance Service’s Customized Database in 2010 and 2015

보건행정학회지 2020년 30권 3호 p.418 ~ 429
최보영, 이해종,
소속 상세정보
최보영 ( Choi Bo-Young ) - Dongyang University Department of Public Health and Medical Administration
이해종 ( Lee Hae-Jong ) - Yonsei University College of Health Science Department of Health Administration

Abstract


Background: This study aims to analyze the cost and the length of stay (LOS) of acute myocardial infarction (AMI) patients with coronary artery stenting according to the characteristics of individuals and institutions.

Methods: The data was collected from Korean National Health Insurance Service’s customized database in 2010 and 2015. Chi-square test, t-test, analysis of variance, and multilevel analysis were performed.

Results: The intraclass correlation coefficients for cost were 7.02% in 2010, 5.61% in 2015 and for LOS were 3.17%, 1.40%, respectively. The average costs were 9,067,000 won in 2010 and 9,889,000 won in 2015 (p<0.0001). However, the cost in 2015 was lower than the cost applying increased fee. The costs increased in aged 50?59 years, 60-69 years, and aged ≥70 years versus in aged under 49 years. The cost was higher in Charlson comorbidity index (CCI) 3 to 4 and ≥5 than in CCI 0. The costs were lower in male, medical aid recipients, metropolises, and local hospitals in other regions in 2010. LOS decreased from 8.1 days in 2010 to 7.4 days in 2015. It decreased in male, high income group, and the group of admission via emergency room. However, it increased in higher ages and medical aid recipients, and it also increased when CCI rose. The Internal Herfindahl Index was related to LOS in 2010.

Conclusion: The variation of hospital level was small compared to the patient level. Therefore, it is important to implement applicable policies at the patient level in order to reduce cost and LOS of AMI patients.

키워드

Medical cost; Length of stay; Acute myocardial infarction; Coronary stenting; Multilevel analysis

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